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Explained: Transformational care and what it means for the NHS

By Léa Legraien
11 May 2018

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Transformational change should be implemented in the NHS to ‘respond to the growing pressures and demands’, the King’s Fund has argued.

But what is transformational change and is it achievable?

What is transformational change?

Transformation refers to change that needs to happen, and leads to radical differences from which there is no turning back.

It’s a thoroughly planned process, which may take time to conduct and requires collaboration.

In the NHS, transformational change would improve outcomes in terms of patients’ health and wellbeing, finances, infrastructure and staff efficiency, for example.

At the moment, several integrative models are in place across the country to transform heath and care. They include new care models, devolution vanguards and sustainability and transformation partnerships (STPs) among others.

Why do we need transformational change in the NHS?

Healthcare think tanks such as the Health Foundation and the King’s Fund argue that the NHS is now at a breaking point, being faced with unprecedented financial and service pressures.

In January, accident and emergency (A&E) performances were the worst to date since records started in 2010, with 77% of patients being seen within four hours – 18% short of the current NHS target.

With 1.7 million employees, the NHS is the fifth largest employer in the world. The Department of Health and Social Care (DHSC) estimates that the service deals with more than one million patients every 36 hours.

According to data from the Office for National Statistics (ONS), the proportion of the population aged 85 and over is projected to double over the next 25 years – reaching 3.2 million.

On the same line, analysis from charity Age UK predicts that one million more people aged 60 and over will live with two or more long-term conditions in England by 2020 – amounting to 7 million people.

Not only would transformational change tackle the growing pressures but also guarantee a stable future for the next generations.

Is transformational change achievable within the NHS?

Implementing transformational change is challenging, as it involves risk taking. Changes mean developing something new, which implies trying and failing before getting it right.

According to the King’s Fund, operating in the unknown requires ‘trust and permission to fail’.

King’s Fund consultant Mandip Randhawa says: ‘In a system where trust is often lacking and failure can have fatal consequences it’s unlikely that meaningful change and transformation can occur.

‘The NHS does not tolerate risk well and inevitably we will see defensive behaviours at play when risk presents itself.

‘These are not conditions that are conducive for service transformation. They are conditions that preserve the status quo.’

When it comes to successful change, collaboration plays a major role, requiring new mindsets and behaviours, as there are often tensions between those who are used to traditional ways of operating and those who are ready to move forward.

Ms Randhawa adds: ‘Until we consider seriously how we approach change it seems that transformation will not be transformational for the NHS at a systemic level.’ 

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