Sir Richard Sykes, FRS, FMedSciformer Chairman of NHS London

LEADERSHIP AND MANAGEMENT – Challenges in the NHS

Lessons learned and implications for the future

Leadership

• The art of motivating a group of people to act towards achieving a common goal

• The leader is the inspiration and director of the action – the person that possesses the combination of personality and skills that make others want to follow

Main characteristics

• Clear vision• Sharing/communicating vision with others so they will

follow• Providing the information, knowledge and methods to

realise the vision – a strategy• Coordinating and balancing the conflicting interests of

members or stakeholders• Stand up for what they believe

Management

The creative and systematic pursuit of practical results by identifying and using available human and

knowledge resources in a concerted and reinforcing way.

– Get the job done

Normal business case

• Vision for the company• Strategy for reaching the vision• Guiding principles• Business plan• Timelines

– Financial implications

Example

• Glaxo 1994 – Zantac patent expiry• Merger with Wellcome• Global integration• Communication and action• Consultants and enablers• Clear lines of responsibility

Principles

• Services should be focused on individual needs and choices

• Services should be localised where possible but centralised where necessary

• Services should be built around truly integrated care and partnership working, maximising the contribution of the entire workforce

• Prevention is better than cure• Priorities should reflect health inequalities and diversity

Polyclinics are an opportunity for the NHS to deliver world class care closer to people’s homes

Polyclinics combine GP

Certain routine hospital services

X-rays and blood tests

Fully equipped with first-class facilities

Modern - DDA compliant

Polyclinics are open from 8am to 8pm every day including at weekends

Individuals and families are welcome to attend them, whether they live, work or are staying in London for a short time, even if they are not registered there

and routine hospital care

A range of useful well being and support services, benefits support and housing advice

Many nearby GP practices are linked to, and work with, the polyclinic as part of the system

Patients still choose to see their own doctor

The benefits include:

Giving people in London more access to doctors and routine care

More accessible, local and convenient

People can still choose to see their own doctor

A faster, more convenient, high-quality health service

Planned around those who need to use it and open for longer for everyone

Extended opening hours to fit around the busy lives of people in London

The vision for transforming primary and community care

London will be served by over 100 polysystems, delivering integrated health and social care services to local communities

The vision for transforming acute care Major acute hospitals will provide rapid access to emergency care for patients suffering from critical conditions. They will only take the most seriously ill patients, and will have all relevant services co-located on site.

Local hospitals will provide high quality, non-complex acute services – ensuring patient access and convenience without sacrificing quality of care.

Some transformation is already underway, with four trauma networks in place across London

London also has three of the UK’s five Academic Health Science Centres

Imperial Health Partners

UCL Partners

King’s Health Partners

‘Too much stuff’

• 31 PCTs• 32 councils• The Mayor• Local MPs• The Commissions • Department of Health

Following publication of the Healthcare for London vision, a major consultation exercise was undertaken led by London PCTs.

This concluded in June 2008 when a Joint Committee of PCTs committed to implementing the strategy.

• Over 5,000 responses, including 200 organisations

• Around 40,000 visitors to the website, meetings and road shows

• An emphasis on quality, safety, outcomes and patient experience

Healthcare for London vision

Lessons learned

• Never trust politicians• Strong leadership and good management will not always

prevail• Health care is based on emotion not logic• Clinicians must be on the front line• The organisation is risk averse• No clear lines of responsibility • Lack of incentivisation• Too many missives• A lot of very well meaning people but not enough leaders

Implications

1. Health care - Affordability- Quality- Standards- Delivery

2. Economy - NHS central role to play in UK Bioscience Industry- Critically important for the economy- Losing business

Clinical trials

A fragmented process characterised by multiple layers of bureaucracy, uncertainty and duplication

Rawlins Report AMS

Diffusion

Innovators

Early adopters

Earlymajority

Late majority

Time

NH

S U

pta

ke

Innovation

Basic research

Applied research

Targeted development

First human use

Clinical trials

Early adoption

Late adoption

Accepted practice (or disuse)

Development

RESEARCH COUNCILS, MAJOR CHARITIES, NIHR (CBRC, SBRC,BRU) AHSC, HIEC

The adoption dilemma remains

Challenges for 2010 and beyond

• Ageing population• Chronic conditions• Moving care out of

hospitals into other settings• Personalised medicine

• Need to use the NHS Reforms to tackle these issues

• Reforms must not inadvertently weaken UK’s position for wealth creation

The future: A Research, Education and Patient Care Cluster