"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.