Transforming the NHS in response to the Darzi review – what next and how?

The National Health Service (NHS) in England stands at a critical juncture, facing unprecedented challenges in access, quality of care, and productivity. The recent Darzi Review provides a comprehensive analysis of these issues and offers a roadmap for recovery.

As an experienced transformation and OD practitioner, with experience of working in and with the NHS, I'm keen to pull out the key messages from Darzi's work – but then a lot of people have already done that. There is also the question about the last set of recommendations Darzi made in 2008 – how come these weren't fully implemented? Let's explore that first.

Why the 2008 Darzi Review Recommendations Did Not Happen

The 2008 Darzi Review, "High Quality Care for All," set out an ambitious vision for improving the NHS, but its delivery faced significant challenges. There wasn’t enough money to make the necessary resources available.

All the deck chairs were moved together without much consideration for the human impact change. This led to "change fatigue" among NHS staff which then hindered enthusiasm, and many experienced staff left the NHS. Gaps in leadership capability and a lack of quality leaders in primary care trusts and allied organisations made driving systemic change difficult.

Shifting political priorities and constant changes in government policy diverted focus from Darzi's original recommendations. Implementation challenges at the local level were underestimated for some proposed changes.

The lack of a clear, robust, long-term implementation plan and accountability mechanism meant many initiatives lost focus and momentum over time. Understanding this is crucial as we consider "what next" from the latest Darzi review.

The Heart of the Problem

There has been a decline in "productivity" caused by (in my opinion) a fatal combination of under-investment, constantly shifting priorities at the top and an out-dated, post-industrial way of working and leading people that still relies on the most highly paid "specialists" in charge of the thinking in their ivory towers, and everyone else left with the problem of making sense of the noise.

Lord Darzi's diagnostic also reveals set of conditions where one part of the system doesn't really talk to the other, IT systems actually get in the way of progress and there is confusion because of the frequency of change that has happened.

For me, the heart of these recommendations lies the critical need for real transformation. This is one of the areas to understand better – we must recognise that the NHS is a national, complex, and nuanced organisation, and any development efforts must account for this complexity. Constantly using a "top-down", "done to" way of working suggests the powers that be are still looking for complicated solutions to a complex problem. We need a more restorative, strengths-based approach.

The Human Cost

The report reveals alarming statistics about staff morale and engagement. For instance, sickness absence has risen by 29% between 2019 and 2022, with mental health issues being a primary concern. NHS staff are losing around one working month per person annually due to sickness absence, far above the public sector average. Again, the current conditions are tuned optimally to delivery the current set of results.

Hope for the Future

I do offer some hope though. The answers are there. We just need to know where to look.

At a recent session with a NHS team, one of the colleagues shared something simple, yet profound. I love working with teams as they offer a micro-lens on what is presented as a macro problem. The team was likened to an army unit that doesn't have the people to carry out the job that it was first intended to do. The colleague then offered a way forward – firstly, to regroup, then to reassess the battlefield, and finally deploy.

I stood back as I heard this, and asked the obvious – "what happens if they don't redeploy".. the answer was.. "they don't exist any more". Sound familiar?

The answers are there. With the people. This person has working in the NHS for more than 20 years in a clinical role. They know. When is the last time their thinking was considered?

What is this People-Centred Transformation all about?

When thinking about the delivery of real transformational change – people are central to the solution. Not just the people at the top – all of the people. I want to offer you, dear reader.. some hope.

I am very fortunate to work with some outstanding NHS leaders who fully understand this. Leaders who want to engage with and involve their people in coming up with solutions together. Leaders who have a profound interest in creating teams where people feel safe to express themselves, try things, fail and learn, where staff from all communities are celebrated, where there is both a willingness and value given to staff development.

In these "bright spots", the workplace becomes a place for wellbeing, a place for different communities to integrate, as a place to pass on wisdom and learn new skills for the future.

It's really easy to take the points from Lord Darzis' work and use it as a stick to beat an already crippled organisation with. I offer hope for the future.

The answer isn't to remove "admin and management", the answer is to talk to the staff and create change from the bottom up. This alone won't be enough.

Leadership that is stable, focused, open and take a long-term view is critical. Leaders who act as stewards of change – that create platforms that bring people together to work on common problems. To work together to explore new multidisciplinary models of care that bring together primary, community, and mental health services. This approach not only improves patient care but also enhances staff satisfaction by promoting teamwork and shared purpose. The answers are there. In the people.

A Three-Stage Approach to NHS Recovery

Taking my colleague's idea and giving it life, I offer you one of many ways in which a plan could be developed. Let's explore this as a thought experiment to see what could happen!

Stage 1: Regroup

In this initial stage, NHS people (not just leaders, but a wider group of thinkers) come together to fully digest and understand the findings of the Darzi Review.

This involves:

-            Lots of dialogue and analysing the data and insights presented in the review

-            Identifying how national trends relate to local contexts

-            Assessing current organisational structures and their effectiveness

-            Evaluating staff engagement levels and areas of concern

-            Mapping existing resources and capabilities

The regrouping stage is crucial for creating a shared understanding of the challenges and opportunities ahead. It's an opportunity to break down silos and foster cross-functional collaboration. This stage can also do with a healthy dose of "contracting" – what is possible with the funding and people we have now?

Stage 2: Reimagine (or Reform)

With a clear understanding of the current state, the next stage involves reimagining what the NHS could be and then focusing on the absolutes (see contracting above) that need to shift first. This creative phase should:

-            Envision new models of care that address the issues highlighted in the review

-            Brainstorm innovative approaches to improving staff productivity and wellbeing

-            Prioritise bringing people together to discuss ideas and learn together through programmes of development and change

-            Conceptualise organisational design and ways of working that can better support the NHS's core mission

-            Tackle discrimination at source and reimagine NHS leadership

-            Design experiments to test new ideas on a small scale

-            Develop strategies for leveraging technology to enhance efficiency and care quality

This stage can be highly collaborative, involving staff at all levels to ensure diverse perspectives are considered and to build buy-in for future changes.

Stage 3: Focused Action!

The final stage focuses on putting the reimagined ideas into action. Not through several hundred ever changing priorities, but a focused set of co-developed actions. This involves:

-            Prioritising initiatives based on potential impact and feasibility

-            Developing detailed implementation plans

-            Allocating resources effectively to support change initiatives

-            Training and supporting staff through the transition

-            Establishing mechanisms for monitoring progress and gathering feedback

-            Iterating and adjusting plans based on real-world results

Focused action can be viewed as an ongoing process, with continuous evaluation and refinement of strategies as the NHS evolves.

I’d love to hear your views!