Planning a service change programme is hard at any time. Differing partner priorities, competing stakeholder expectations, and challenging political environments are just a few of the many variables that demand our attention when we’ve got that blank Gantt in front of us.
It’s no wonder, then, that the first things we reach for are those few old faithfuls we can rely on as the basis of our plan.
I’m talking about the governance, regulatory, and procedural aspects of service transformation programmes that are old friends to those of us who know them well.
These bodies, these laws and regulations have been the bedrock of our service change programmes for the better part of a decade. These have been the things we can rely on in a sea of variables. Lashed together they give us a raft of knowns we can use to steer change in unpredictable waters.
The Health and Care Bill progressing through Parliament will mean these familiar paragraphs, our reliable old faithfuls will change themselves. And small changes on paper mean big changes for major service change and transformation programmes.
Nobody knows better than service transformation leaders that change brings challenges and opportunities. So you won’t be surprised to hear that these are the questions even experienced programme directors, and patient involvement and public consultation leads are bringing to us right now.
So what variables should we be thinking about when we’re planning?
A service transformation programme timeline is always top of the list when a new programme gets underway. It gives certainty. It shows there’s a plan. It communicates credibility. It can often be approved before the programme director has had a chance to appoint governance, or crucially, patient involvement and communication leads. And that’s a shame, because it’s these factors that often mean the initial plan has to be revisited pretty early on.
In these cases it’s common for the key milestones and deadlines in the plan to be moved, meaning the credibility the programme leadership has gained among senior stakeholders by getting a plan out early, can quickly erode.
Right now it’s external factors, the Health and Care Bill and the NHS response to the COVID-19 pandemic, that are making the biggest impact on plans and timelines. We’ve been helping our clients reschedule their programme timelines to account for the recent announcement that the date on which ICBs (integrated care boards) will formally come into being has been moved to 01 July 2022. A three-month delay on the long-trailed 01 April. A necessary delay and better for all sorts of good reasons, but a delay nonetheless and one with a huge impact on leadership, governance and decision-making.
Moving some programme timelines to an indeterminate point in the future might be possible. Many of the change programmes we’re working on don’t have that luxury, because they are critical and have to be delivered to make services safe and sustainable.
Thoroughly mixed in with the issues the Health and Care Bill brings us for our timelines is a whole pile of governance issues.
Delaying the implementation of ICSs and ICBs from 01 April to 01 July is, we’d argue, necessary in the current circumstances.
Many ICSs (integrated care systems) have no permanent leader appointed as yet and our clinical leaders’ attention is firmly and rightly focused primarily on the pandemic response. And with winter far from over, the question for many of us is: is a three-month implementation delay enough? Should it be delayed again? Another three months?
What does it matter, you ask? Someone is always in charge. There’s always a decision-making body. That’s true, of course. Procedurally there should be a smooth transition – the decision-making body is dead; long live the decision-making body. Practically, though, the people will change. Organisational memory will be affected. Expertise and experience will be lost.
That means the new bodies are unlikely to be as comfortable with the issues as their predecessors. Some will not be as confident with the procedural requirements. Many of the people will be unknown to key external stakeholders critical to the process. All of these affect trust and confidence. All affect the pace at which your service transformation programme can move forward.
Another effect of the changes is that some of those spiky, locally controversial changes – the temporary closures of urgent care facilities, wards in community hospitals, birthing units and the like that had already hung around for ages when they were postponed and delayed by the pandemic and are still unresolved – the effect is that these will be carried over to the to-do list for the new bodies.
Hardly the way for a new body to get off on the right foot with local stakeholders and a reluctance to address them might allow the issues to fester longer.
3. Powers over service reconfigurations
Perhaps the biggest and least predictable of the changes proposed by the Government are those aimed squarely at service reconfigurations. These proposals would give the Secretary of State sweeping powers to intervene in local service change issues. And if proposals published in the White Paper are implemented in secondary legislation, upper tier local authorities will lose their powers to refer service reconfiguration proposals to the Secretary of State for review. Either could mean a massive upheaval. Together they could be seismic.
The proposals for new powers for the Secretary of State to intervene have been hotly debated in the House of Lords as the Bill goes through its committee stage. A raft of important organisations have expressed concern about the lack of detail in the proposed powers and the effect on long-established, proven ways of working.
Of course the proposals will be debated and might be amended. It’s likely there will be new procedures, updated regulations and new guidance. All will take time to develop, publish and embed. So perhaps we should see this as a series of changes over time. An evolution, not an event?
There’s lots being written about the implications of these potential changes. The thing that matters most to those of our clients with service change programme plans on their desks right now is: how will their sometimes unpredictable local health overview and scrutiny committees react to potentially losing their referral powers. There are many delayed transformation programmes already in the system. Add to those a potential logjam of locally sensitive, temporary service changes that were made in response to COVID. If local authorities react to the potential for their referral powers being withdrawn by referring even a small number of the issues while they still can, the system could be swamped.
Thankfully the potential for these changes also presents opportunities. Combined with the opportunities presented by timeline and governance issues, we’re helping our clients resolve issues that they’ve been carrying for too long more smoothly and quickly than they’d ever thought possible, even just a few months ago.
We’ve helped clients overcome long-standing, long-discussed maternity service issues in the Midlands by charting a new course to achieve programme objectives without the need for a controversial public consultation. We’ve worked with clients to secure agreement from local politicians to make permanent highly-controversial changes to a remote urgent care facility in the South West. And we’re supporting systems to chart timelines that resolve other issues before ICSs take over that would otherwise be a dead weight for the new organisations’ leaders to carry.
Sometimes it just takes someone external and experienced like us to spot the opportunities in the challenges change and uncertainty present.