“Smoke and Mirrors”
Top Hat …Wand … Rabbit … Money? What do these have to do with formal change management, benefits realisation and a return on investment? = Absolutely nothing
Except this is exactly how I describe the challenges and experience of being a benefits manager in terms of that … drum roll please … “TADA” moment!
Where everyone looks for a way to magically materialise monetary value to the benefits that have been discussed in a general way for a very (sometimes very) long time, and with minimal resources – if not flying solo to somehow achieve all this – where I will share some lessons learnt and practical advice in part 3 of this blog.
So, when conveying an unpleasant message there’s a tendency to sandwich it between two more appetising slices, so this is the bit in the middle ….
Firstly, a challenge on the current UK governance and funding approach to the NHS.
So, my perception is that HM Treasury see the NHS as a ‘money pit’ in the same way it views the Education sector – but where there are obvious and clear positives for all citizens in the UK in terms of (to a degree – and arguably still) some of the best free and available education and healthcare in the world.
Within the Civil Service, and drawing on my own experience within HM Revenue and Customs aka The Tax Office (please boo later), they have a traditionally high level of engagement and understanding with HM Treasury in terms of business case proposals for the spending review cycle.
This is underpinned with a clear approach and resourcing in benefits realisation, in terms of a centralised team with a standard mandatory framework, guidance, training and templates, including senior benefits SMEs who essentially case-manage and oversee progress, providing early advice and mentoring to new benefits managers across the organisation.
To give you an idea of the scale of this – as a comparison to the NHS, for approximately 25,000 staff there would usually be a 150+ strong PMO with dedicated benefits managers at both project and programme level. So, if you are within a Trust or ICS – consider how many staff have project or change or transformation or even benefits as part of their role, (search the org chart maybe?) plus where they may well be wearing numerous others hats and where this can be buried in a wide range of priorities and focus. See the challenge?
Taxpayers’ money also funds our UK Infrastructure and Defence and so on where there are varying degrees in the maturity levels of benefits realisation awareness, implementation and resourcing across these organisations but where the mandatory nature of this stands out as critical to its success. From engagement with public sector benefits experts, I see maturity levels in some organisations, also closer to HM Treasury than current NHS levels.
There is even a UK British standard for benefits that has been developed, albeit this doesn’t envisage it being used for healthcare but with a nice ‘cop out’ in terms of ‘’the standard can be used in any industry, but is expected to be used primarily in” (big list but not healthcare).
BS 202002:2023 | 26 May 2023 | BSI Knowledge (bsigroup.com)
So, to benefits realisation in the NHS
Some encouraging signs of engagement and a desire to understand and truly tackle this area both within the NHS and wider networking through LinkedIn and other forums where I believe it’s becoming increasingly important (and I know I would say that) but to me in terms of both public and parliamentary perception this is critical. Personally, my concerns have grown over the past few years that if the NHS doesn’t show this return on investment, given all the publicity and vast sums invested, it risks arbitrary enforced privatisation particularly under a new government or governance regime in the near future.
There is also a changing landscape of professional organisations, bodies and suppliers deeply embedded and welded to and surrounding the ‘core’ of the NHS where I feel we need to acknowledge and work together to leverage this collective, as a great deal of former and valuable NHS experience now sits outside of its borders.
And as an example, you have only to look at recent initiatives such as this – NHS England £16 million opportunity for “Tiger Teams” to support EPR delivery – htn
I sincerely hope every Trust is looking outward and across its networks not just upwardly (in terms of NHSE funding and reporting) to make the very most of opportunities and latest thinking.
It was also excellent to hear at a recent NHSE Front Line Digitisation (EPR) Programme training session on their CORA reporting system that it’s been made clear that benefits reporting is a mandatory requirement within the Investment Agreement documentation for EPR funding which Trusts have signed up to.
There is a great deal of central NHSE guidance and toolkits, albeit these aren’t mandatory given the structure and complexity of NHSE and the Trusts across the country, but I’d strongly suggest early engagement and exploration of this support, especially given that some advice and information is now ONLY available via NHS Futures FutureNHS Collaboration Platform – FutureNHS Collaboration Platform and not held or regularly shared and highlighted elsewhere.
And finally on this subject – there are already signs of an understandable but slightly concerning shift through HM Treasury embedding roles within the NHS (which I called out and expected to happen eventually) together with the commercial and banking backgrounds from more recent NHS non-executive appointments.
We all know the world runs on finance but surely for a national healthcare service there should be more of a genuine focus on both financial and non-financial health related benefits, not purely a monetary return on investment (this is not HM Revenue and Customs – I can vouch for that!)
And now for something completely different – but not wholly unrelated so a second important area I want to highlight but with no easy segue, however there is some light entertainment in the form of a rap video (I kid you not, second link below as a heads up)
If you would like some new or different food for thought in terms of the challenges that EPR and digital transformational changes pose, then the following videos are both excellent and insightful by nature of their contrast and similarities:
Larry Weed’s 1971 Internal Medicine Grand Rounds (youtube.com)
EHR State of Mind | An Electronic Medical Records Parody (youtube.com)
From my own experience in private healthcare (even working for a VC backed organisation) there was always stretch and a clear percentage of time for appointments incorporated for clinicians immediately post go live, through planning ahead operationally to allow for familiarisation with new systems, especially in moving from paper to digital.
Lessons learnt showed that anything else was nonsensical where some very experienced doctors, nurses and AHPs were seriously considering career moves if this proved too much, given years of expertise in their own specialisms, working mainly on a paper-basis.
To be faced with feeling like a new starter again, where technical skills obviously can vary greatly, needed a lot of understanding and careful handling by the organisation to ensure it retained their talents which overall was navigated and handled well (and I was a project manager overseeing clients migrations to an online portal – part of which included agreeing this bedding in period with the clinician and nursing managers, so I am not speaking in generalities here).
Yes – I know there are clear safety improvements for patients and check lists and digitally assisted decision making as part of EPRs etc. but to seek to implement such a significant change with no breathing space or flex or allowance for embedding and expect everything to be intuitive (your first iPhone maybe if you were lucky) is putting the realisation of benefits at risk of taking significantly longer than expected, apart from all the other potential disbenefits and more importantly the possible risks and concerns this raises and the pressure it puts clinicians under is pretty untenable but doesn’t seem widely discussed.
Happy to engage and debate this or any of the above from a benefits POV and where Part 3 will be gentler I promise!