NHS cuts – a fresh chance for innovation?

Over the next two years, the NHS budget will top £205 billion - and then the cuts will come. David Nicholson, NHS Chief Executive, has said that the NHS will have to make ‘efficiency savings’ of £15 - £20 billion from 2011 to 2014. So how will the NHS cope? How can it improve quality; increase productivity and find innovatory ways to shift the organisation from a ‘sickness’ service to a promoter of wellbeing?

The need to make that shift is beyond doubt. Keeping people fit and healthy and out of hospital, for instance, by managing long term conditions better in the community, is an imperative for both the quality of life of individuals, and to deal with future financial pressures.

Two steps have to be taken to help make that shift happen. The first is that politicians begin to tell a different story about the NHS. Instead of concentrating on hospitals, acute care and waiting times - important as they are - Labour and Conservative politicians need to highlight the hugely varied and imaginative ways in which preventative measures are beginning to make a difference. A difference that is especially important to communities in which deprivation and the absence of neighbourhood regeneration means that health inequalities hit hardest so life is shorter and, often, more restricted and painful.

The political narrative has to start referring to measures such as health trainers, recruited locally; subsidised gyms and healthy living centres that offer training, nutrition classes, parenting support, debt and benefits advice, courses and guidance on how to self manage a long term condition.

Second, the risk-averse culture of the NHS that severely hampers innovation has to be transformed. Of course risk-taking has to proceed with caution but if it doesn’t happen at all, then all the current conversations around innovation, will be simply that: so many words.

Many of the NHS’s 1-2 million staff have very sound suggestions on how to improve or devise new services. Too often, however, these ideas find no practical outlet. To accelerate change, a ‘right to request’ ‘spin out’ has been established that recognises that all front-line staff have the option to set up a social enterprise, and if it is viable, to keep their NHS pension and, receive a three year contract from the NHS. In addition, the Social Enterprise Innovation Fund (SEIF) has £100m to invest in innovation. and the Regional Innovation fund (RIF) controlled by the Strategic Health Authorities has another £220m.

While a step in the right direction, SEIF and RIF money amount to pennies in comparison with the NHS’s entire budget. Second, the aim of this fresh generation of social enterprises is not to replicate existing NHS services. It is to offer a different concept of holistic preventative care that puts the patient in charge and improves wellbeing and quality of life.

At Health Launchpad, we’ve been engaged in this field for several years, learning from our mistakes, and improving what works well. We offer financial investment and, crucially, practical support, trying to steer the novice social entrepreneur from his or her original concept, through the pilot stage and on to the creation of a scaleable, sustainable venture that has genuine social impact.

As part of our offer, we also embed a Social Entrepreneur in Residence in a PCT or local authority (sometimes working across both). The SEiR works locally but has strong links with the London Health Launchpad team, drawing on its contacts, expertise and links with NESTA and government. The aim of the SEiR is to nurture a culture of innovation in a PCT that spreads like a virus; to clear a space that allows innovation to happen; to spot entrepreneurial talent and to be the first port of call for a member of staff who wants help, for instance, on how to draw up a business plan and handle issues around intellectual property.

The publication sent to NHS staff to inform them about their right to ‘spin out’ and set up a social enterprise, says, ‘The most important reason for making a request will be to improve the service you want to deliver and to respond to an unmet need. If you think that the social enterprise model with its independence, flexibility and community involvement is the best way to achieve this change, then you should consider putting in a request.”

Often, times of financial crisis are the most fertile for growing social enterprises and innovatory projects that are scaleable, sustainable and can change peoples’ lives for the better. But for that change to be triggered - first, senior and junior management have to have faith in the power of a good idea.