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How to be world champions: a new approach to the UK’s health system


Nora Colton
By Professor Nora Colton, Director of UCL Global Business School for Health
9 January 2023

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Imagine you’re watching a 100-metre sprint between two equally talented athletes. When the starting pistol fires, the first athlete bolts out of the blocks, giving it everything they can muster. The second takes a more measured approach, holding back some energy. Yet they still manage to win the race.

This is the so-called 85% rule. By operating slightly below capacity, the second runner had space to focus on other factors such as their form, pace, and environment. By adapting and optimising, they were able to have the edge they needed to outperform their competition.

Right now, the NHS is that first athlete. It’s in a permanent state of crisis, constantly responding to emergencies within the system. As a result, healthcare leaders are overwhelmed, with no capacity to stop and reflect on long-term solutions.

This is particularly true of the move to Integrated Care Systems (ICSs). Given overlapping powers, tightening budgets, multiple stakeholders, and the expectation of 100% delivery – despite transition from clinical commissioning groups (CCGs) – has meant that ICS leaders barely have the headspace to work through growing pains.

However, there’s a new opportunity on the horizon to get this right. In his Autumn Statement, Chancellor Jeremy Hunt announced that former Labour Health Secretary Patricia Hewitt would lead a review into ICSs. This is a critical moment to break away from old habits and find long-term solutions to the problems in our health system.

There are three things the review should consider.

First, it must look at solutions beyond the world of healthcare. Like the athlete who studies the endurance of tennis players or the agility of ballet dancers, the UK’s healthcare system should take lessons from the private sector.

After all, every hospital is a multi-million-pound organisation. And, since the introduction of ICSs, they have had the mammoth task of driving change in pre-existing structures. Leaders could learn to manage this change by looking to successful CEOs who enter old organisations resistant to change, or business leaders who create unity after a merger. The scale, complexity, and unpredictability of managing much-needed changes to healthcare requires talented leaders with significant economic expertise and financial acumen.

Second, the review should look at successes from healthcare systems around the world. In the Autumn Statement, Hunt said he wanted an NHS with ‘Scandinavian quality and Singaporean efficiency.’ Yet the give-it-your-all attitude expected of healthcare leaders has meant there has been no time to study the systems of these countries and apply lessons to the NHS.

Consider Denmark’s investment in digital health infrastructure, which has revolutionised the country’s healthcare provision. The Danish health service has 28 robots which carry out surgeries, with systems in place to monitor patients remotely. This is only possible with time and investment. The medtech industry accounts for 7.4% of Danish business. To achieve similar innovation in the UK, we need to stop demanding immediate results and embrace delayed gratification.

Third, the review should look at how to give healthcare leaders space to think. This is about investing in better leadership training, instead of expecting people to ‘learn on the job’.

Many influential commentators have talked about the need for a new approach to leadership within ICSs. For example, The King’s Fund has argued that change cannot be achieved through simply ‘imposing new structures’, but requires ‘organisational development and culture change’. Healthcare Leader’s own report into the end of CCGs also noted the importance of training in medical leadership. As one interviewee poignantly commented, with reference to ICSs, ‘How can GPs suddenly run a billion-pound organisation?’ Taking stock and investing in the long term is crucial.

So, learning from the private sector, taking the best of foreign health systems, and giving healthcare leaders space to think are all important ways of creating an NHS that’s fit for the future. At UCL, we created the Global Business School for Health (GBSH) – the world’s first business school dedicated to training tomorrow’s healthcare leaders – to be part of these three solutions. The need for such a business school became particularly clear during the pandemic. As a result, GBSH’s founding pillar is to bring together diverse, international, multidisciplinary approaches to solve some of the biggest challenges in healthcare. It’s this kind of thinking that eluded healthcare leaders in the UK because of the never-ending spiral of fire-fighting they must endure.

GBSH is proudly helping healthcare leaders value that 15% ‘breathing room’. The Government’s review is a huge opportunity to help to deliver it. Let’s use it as a moment to stop thinking about how to get through the next crisis, and focus instead on what will make us world champions for years to come. We would do well to learn from the athlete, giving 85% when it matters most, safe in the knowledge they’ll have enough energy in the tank to make the smart decisions needed to win.

By Professor Nora Colton, Director of UCL Global Business School for Health

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