What will healthcare look like over the coming decade? Interview with Nigel Edwards

Saxton Bampfylde are delighted to bring you Future Health, a short series of interviews from both experienced and emerging leaders in the healthcare sector to consider what the next decade will bring – looking at the challenges, opportunities and need for change.

For our first interview, we speak with Nigel Edwards, an independent health policy expert working as an advisor with WHO and a number of UK organisations including PPL and RAND Europe. Nigel was Chief Executive at the Nuffield Trust from 2012 to 2023. He has a long career in health policy and working on innovation and change in healthcare delivery and in providing challenging analysis on health policy.

 


You have been the Chief Executive of the Nuffield Trust for almost a decade. As you move forward to new challenges within the healthcare sector we would love to hear your reflections on the past ten years in healthcare: what surprised, heartened and challenged you during this time? Has the healthcare landscape changed as you had anticipated when you began in this role or have you been surprised?

I have been continually heartened by the people running services locally, particularly in primary care settings. They are getting on with the job, being innovative, trying their best and succeeding in very difficult situations. It is important that leaders go out and experience that work and meet those people and see what they are doing to implement change at a local level. That creates a huge boost.

If I reflect back to what surprised me, it really is the extent to which the civil service and the decision-making processes in government have been shown to be not fit for purpose for the complexities of health care. The Covid pandemic really demonstrated that. When I came into this role there was a good narrative for the NHS about integration, but not enough focus or a clear strategy; there were too many objectives and the long-term desire to invest in community and primary care was not really happening.

That is my key reflection on the past decade: the organs of government that we’ve taken for granted as being quite efficient and well run just haven’t been. The dysfunctionality really came through in a number of aspects of the response to the pandemic and the NHS is a system that is massively centralised in a number of ways and oddly decentralised in others. It has too many priorities and no well thought through theory of change. It has spent too long obsessing about the way it’s organised and governed rather than actually getting on with the real business of changing the way that health care is delivered.

Innovation and change have been important throughout your career. These are continuing themes of healthcare – what do you see as the key innovations of the next decade and what type of leadership is important to capitalise on these?

For the NHS to survive and prosper, it’s really got to do something to shore up general practice and primary care more generally. It feels beleaguered and under pressure and the response to the scale of the problem is not proportional. There needs to be innovation in the type of leadership approach and the appetite for and investment in, change management. It will be difficult to deliver and will require different models to achieve it, but the innovation is absolutely necessary.

A big innovation that we’ve not capitalised on, despite putting budget towards it, is achieving the benefits of digitisation. Whether that’s automation of routine processes or joint health records through embedded pathways, reminder systems, or population and health management to join up different bits of the system, and really allow more data to be available for analysis and help determine strategy. These digital tools could help clinical workflow in a way that is helpful rather than painful to all health care settings. The issue is that the investment in organisational development and change management capacity to make the most of this is just not there.

 

“To embed innovation to make change we need leaders who are really good at helping to manage both these things and who can work in a cross-organisational structure and culture.”

 

The final point on innovation is perhaps more threatening: the expensive drugs and therapeutics which are coming through will create some challenges to the system in terms of affordability and distribution. I believe this may lead to some tricky conversations further down the line.

To embed innovation to make change we need leaders who are really good at helping to manage both these things and who can work in a cross-organisational structure and culture. The approach needs to be facilitative and respectful. The people who’ve been successful are able to create a barrier between the top-down pressures and the local frontline staff to allow them to get on with their work and deliver as high quality service as much as possible.

A focus of your work has involved researching, developing and implementing new models of service delivery. Future healthcare systems will rely on many of these but who are the leaders best to drive these changes?

The answer to that depends on who should have key decision-making rights within the system. I believe that should be more devolved than it is. We need to give local leaders the ability to decide what should be standardised and minimise the number of high-level interventions.

However, I do think we sometimes focus too much on senior leadership and we need to look more at what is causing burnout and stifling staff retention. We need to look more at the micro level and what drives patient experience and care. That is frontline and middle management and supervision. They are the people who often make the biggest difference and when they are poor, staff leave. This is not just specific to the UK, this is a problem of health care all over, and we need to address this.

Nigel, you are just back from a WHO conference, an organisation you have been involved with for a number of years. As we look ahead to the next decade are there lessons that you think UK healthcare leaders can take from other countries?

The first lesson is to reduce the levels of centralisation and create more autonomy at the provider level. We seem to have too many competing priorities compared to other countries’ health systems and that creates a level of hyperactivity in our system.

I would suggest that we can learn more about community and primary care. We’re good at it but we have let the hospital system grow rather more than is perhaps ideal. This has led to a starker distinction between social care and health care and I think we can learn more from other countries about how to integrate these better.

The UK is regarded as a source of lots of innovation and I would say there aren’t many policy ideas in other countries that are not being implemented here – skills mix and extended roles for nursing, for example. In the implementation of our paramedic work we’re ahead of much of the European region.

 

“We need more systematic approaches to improvements and change with more focus on the well-being of staff and the quality of their jobs, ensuring that they have autonomy, mastery and purpose. If you do that you’re very likely to have really good patient care.”

 

There is still a very strong political focus on health in other countries and huge amount of government spending but it is less of a political football in those regions where there is more emphasis and funding through social insurance. It seems there is more of a social dialogue about the way that healthcare is run and by whom. But I would caution against the malign effects of private equity ownership in health care systems – this exists in some other countries and we have seen examples in nursing homes in this country and we really do need to be careful of this.

Lastly, as you reflect back on your career what advice would you offer to the future generation of leaders in an evolving and often challenged world of healthcare?

We need a much clearer focus on the experience and work of frontline staff. We need more systematic approaches to improvements and change with more focus on the well-being of staff and the quality of their jobs, ensuring that they have autonomy, mastery and purpose. If you do that you’re very likely to have really good patient care.

Paradoxically the rhetoric of focus where the patient is central to everything may be an error. Perhaps it ought to be more staff focused: if you look after the staff and they’re clear about their purpose, they will deliver the best patient-centred service.

 


Championing outstanding leadership in Healthcare

At Saxton Bampfylde we know the importance of game-changing leadership appointments for the health and care ecosystem. Our dedicated team are proven partners in supporting critically-strategic appointments at the most senior Executive and Non-Executive levels in the Health & Care sectors. From start-up healthtech businesses to leading NHS Trusts; from private healthcare businesses to national institutes and emerging NHS system leaders.

Our recent Track Record Includes:

  • Central London Community Healthcare NHS Trust
    Director of Strategy, Partnerships and Integration
  • Derbyshire Healthcare NHS Foundation Trust
    Director of Finance
  • Marie Curie
    Chief Nursing Officer
  • General Pharmaceutical Council
    5 Council members

 

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To find out more about our work, contact Alex Richmond, Head of Health Practice

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