"There is no point in informatics trying to enable a
change in one direction when budgets are encouraging maintenance of
the status quo," said Sheila Bullas, secretary of the BCS's Health
Informatics Forum, at a recent BCS leadership debate on
transforming health services.
One of the first points raised was that the NHS is a chaotic and
rapidly changing environment to work in. It was suggested that
those who tried to raise the bar got little reward as management
then went on to raise the bar again. Apparently, the NHS does not
do reward systems very well, and the finance system was also
labelled as disincentive to change.
Instead of fighting change, the NHS should celebrate people who
transform things, delegates said. GP fund holding is a good example
of transformation that has worked well. GPs can change things
quickly and can also guarantee the benefit of doing so.
Some delegates said that foundation trusts are too big to
transform and the incentives are not there.
One of the speakers noted that the private model will not always
work well for the NHS. In the NHS, you do not have the same vision
and it is not shared between all the different areas, the speaker
said.
However, when it comes to transforming, a lot of the time it is
dependent on having enough staff. According to one person you need
3,000 staff to make change happen in a health community.
However, this is not the case with transforming the way that GPs
work. The trouble here is that there simply is not enough money to
employ the staff.
Speakers said that the current situation in the NHS is a
one-size-fits-all approach that staff have to fight against.
The key to encouraging people to adopt change is to get the
early adopters to coach others in the use of new systems, speakers
said. The NHS needs agility, a realistic timeframe and experience
to draw on.
Others said that NHS transformation is not a single, monolithic
challenge but is rather an ongoing and necessarily flexible process
of evolution. It was agreed that the NHS needs to use sticks and
carrots to make transformation work.
Finally, it was agreed that the NHS is only national in name -
it is made up of a lot of independent, regional parts. Therefore,
just because a change works in one place, it will not always work
in every other area of the service.