Improvement's role in turning election pledges into NHS practice

After polling day, as the next government turns to implementing its plans, what should be prioritised to turn its pledges into NHS practice? Achieving waiting-time targets, making the most of new technology and shifting care models will require more than a handful of big ideas.

Sustained, stable investment and more staff will be essential. But on their own, they won’t be enough to transform services and meet future health and care needs. People across disciplines and sectors will need to collaborate to test innovations large and small, with the organisational capacity and capability to ensure this work is aligned and supported. A broad and sustained programme of service change is required.  

Well-evidenced improvement approaches will be an essential part of the mix when it comes to designing and delivering the change ahead. Improvement is about giving the people closest to issues affecting care quality the time, permission, skills and resources they need to bring about measurable improvements. These approaches are now being used in a wide range of contexts and should be considered core to delivering organisational goals. 

As manifesto ideas filter down from broad statements into the day-to-day practice of staff at a national, regional, local and service level, improvement skills and knowledge will be critical. This blog describes improvement’s role in reducing waits while maintaining or enhancing quality and productivity: a major focus for the main parties. And it points to what national and local leaders should prioritise to help make the most of this contribution.   

Reducing waiting times through new capacity 

The main parties’ manifesto commitments on reducing waits focus principally on increasing capacity or activity, with multi-year timescales reflecting the scale of the challenge ahead. The ambitions are not just to reduce the hospital waits that tend to grab the headlines, but improve access across primary, community, mental health and social care services. 

Improvement can help ensure precious additional capacity and activity is well targeted and embedded. Improvement offers methods to collaborate with staff to map pathways, capacity and demand to identify the bottlenecks where the services they deliver are getting stuck. 

This analysis allows organisations to be confident scarce resources are where they need to be and can help identify waste and how resources can be reallocated. Proper analysis often leads to counterintuitive conclusions. For example, unless carefully managed, running additional clinics and theatre lists at weekends (as Labour is proposing as a key part of its recovery strategy) can create unanticipated problems – not just through the risk of overstretching staff already under significant strain. Increasing activity at one point in a pathway can create delays and inefficiencies downstream, ultimately limiting the benefits for patients. Both national and local leaders need to understand the whole system before deciding where and how to inject capacity to ensure the best use of resources.   

Improvement can help reorientate capacity to improve care even in challenging contexts and in advance of additional capacity or where expansion isn’t possible. For example, both the Conservative and Labour manifestos identify enhancing continuity of care as a priority. Novel Health Foundation analysis informed a programme that supported practices with improvement approaches to design ways to enhance continuity for patients that also enable timely access overall and increase efficiency and quality. 

New service models enabling change at scale

As well as expanding activity and capacity, each of the main parties propose new service solutions that represent a significant expansion or reorientation of service capacity. For example, the Conservatives plan to build 50 new Community Diagnostic Centres, while Labour is proposing Young Futures Hubs and the Lib Dems are pledging walk-in hubs for children and young people. 

More substantive changes such as these deserve robust system diagnosis and implementation support. Plans should recognise that service solutions will need to be co-designed with all those who deliver and receive care. Teams then need support to adapt and embed new care models in each place they are implemented if we are to be confident of success. This process is complex, benefitting from effective collaborative learning processes within and between the places implementing the change. 

Improvement can help leaders take a whole-system approach to these new initiatives. We need to understand and redesign existing systems and pathways to ensure, for example, that new services such as centralised diagnostic centres don’t simply suck staff capacity from elsewhere and generate activity figures that look good for one part of the elective recovery story while creating problems elsewhere.  

The manifestos provide some welcome proposals on public health, prevention and broader cross-sector strategies to improve health. As we move into this broader territory, which spans multiple organisations and sectors, improvement methods remain highly relevant but there are additional considerations. Through a partnership between the Health Foundation, Q Community and NHS Confederation, we are exploring the strategies needed to accelerate sustainable transformation across whole sectors and supporting peer learning in this space, recognising the complexities and approaches needed to deliver change on this scale.    

Creating the foundations: organisational and system capacity for collaborative change

How quickly any new government can implement its ambitions will be determined by the capacity and ability of local organisations to introduce these changes with staff and populations. National leaders can provide welcome clarity on priorities, and the space for local leaders to work with staff to create a coherent portfolio of work that engages the population and partners, and pays particular attention to locally underserved groups.

Each of the many changes that organisations are expected to deliver will impact the working lives of the teams delivering care and will need to be owned by them if they are to be sustained. This will be doubly challenging given the resourcing context and need to improve productivity in parallel with meeting other goals. If organisations are to be confident changes will stick and scale, learning from the Health Foundation’s Q community shows they need to ensure a sense of shared ownership and create the right culture, as well as the capacity, capabilities and a clear rationale around each change.   

While local leaders need to build their internal capacity and culture for change, system leaders need to nurture mechanisms to scale and share between organisations. Evidence on the adoption of innovation demonstrates that each place that introduces change needs go through a proportionate process of diagnosis, identification and adaptation of solution ideas before implementing these iteratively. Drawing on existing evidence is a critical starting point but relying on case studies is unlikely to suffice. Given the complexities of introducing service change in varied organisational contexts, learning from others going through a similar process is a key enabler. 

There’s understandable urgency to meet goals quickly, but the need for internal capacity and effective sharing between sites is the reality of change in a complex environment like health care. The good news is that the UK health sector can build on several decades of growing capacity in improvement and has many strong networks in place to aid scaling. For example, the Q Community – established by the Health Foundation, NHS England and partners across the UK to bring together people with improvement skills – has attracted over 5,700 members. The Flow Coaching Academy has helped spread expertise in the system analysis and redesign methods described in this blog, with a body of over 250 methods now available for people to apply locally. 

Longstanding networks and capacity can be complemented by fixed-term support in priority areas. The use of improvement collaboratives was a prominent feature of how the Labour government in the early 2000s supported organisations to achieve measurable change. Plans for communities of practice and collaboratives, were referred to by Amanda Pritchard at this year’s ConfedExpo as part of a major focus from NHS England on improvement. These can play an important part of the solution in enabling change at scale.

Whatever the outcome of the election, the main parties’ manifesto pledges indicate service leaders will face a major and extended programme of radical change. Building the right organisational foundations, system analysis and learning structures around this work will be essential. Improvement expertise – already present in all corners of the health sector – can and should play a key role in creating the momentum needed.