NHS reforms: the challenges for leaders and how to deal with them

NHS reforms: the challenges for leaders and how to deal with them Our survey shows just 30% of managers think the restructure will help them deliver savings – here are some tips for success.

The challenges of an ageing population, the cost of new drugs and treatments, and growing expectations of what health services should deliver despite stagnating funding have triggered a fundamental shift in how healthcare in the UK is commissioned, provided and regulated.

Recent NHS reforms have overhauled the system with the aim of enabling it to overcome these issues – but how successful have the reforms been?

Acknowledging just how challenging the implementation of any change can be, and given the scale of this particular transformation, we commissioned our Fit for the future? research in order to understand how senior leaders are coping with the impact of these reforms on their organisations and the sector as a whole.

Our survey of more than 150 leaders from across the health sector identified concerns about the effects of the reorganisation. We found that only 42% of leaders are optimistic about the ability of the NHS to deliver high quality, cost-effective care over the next five to 10 years; and fewer than 30% say the reforms have had a positive impact on their ability to deliver efficiency savings.

These concerns are not surprising given the scale of the reorganisation and the fact that the new system is still in its infancy. In our experience, major change in any sector or organisation is difficult to get right and takes time to embed before intended benefits can be realised.

Such transformational change can often result in productivity challenges as people have to adjust to new roles. Irrespective of process maps and organograms, effective business is undertaken via relationships – both formal and informal. Therefore, key questions faced by leaders and their teams in an overhauled system will include: on which organisations am I dependent to deliver my strategic goals? With whom should I build relationships?

From our survey data, we identified three main challenges and looked at what leaders can do about them.

1. The absence of a clearly communicated vision is creating a disconnect within and between organisations across the sector: our research found that only 21% of non-board respondents believe there is a clear vision in place for their organisation. At board level, this rose to 60%, indicating an internal disconnect. Leaders must create and communicate a compelling vision for their organisation so that management, staff and external stakeholders have a clear understanding of what is expected of them.

2. Change is not being managed effectively, risking failure in realising the transformation's intended benefits: although change is constant, many health sector leaders say the culture of their organisation does not encourage change and may even hinder innovation. Only 15% believed the sector's culture even slightly encourages change. Leaders must promote an understanding in the organisation of why change is required, and ensure that the development of capability to deliver change is embedded in resource planning. There needs to be an honest appraisal of what capability is possessed, and where gaps lie.

3. Uncertainty around how to collaborate is diminishing organisations' ability to find joined-up solutions: survey respondents acknowledged the need for integration across the sector, yet in its early phases, a fragmented system presents challenges around how and with whom they should be collaborating.

The new system is aimed at ensuring that well-performing organisations continue to succeed, while those that are performing poorly may be allowed to fail. Research showed 15% of providers expect there to be a reduction of 50% or more in the number of commissioning organisations over the next five years, and 63% of commissioners feel the same.

If individual organisations are well run, but sit within a failing health economy, they too will eventually fail. Leaders must therefore invest time in developing and maintaining relationships, enabling a collective effort to address those challenges that one organisation cannot overcome alone.

The scale of change in the health sector means it will take time for it to operate at full potential. However, the system is incredibly resilient, determined and focused on meeting the challenges of change. We are already seeing the development of longer-term visions – breaking the claustrophobia of annual planning, and a more collaborative approach to strategic planning.

These early positive developments are reason for cautious optimism, but much remains to be done.

Richard Jones is executive director at Moorhouse Guardian Professional.