Busting bureaucracy for people working on the frontline
Health and Social Care Secretary Matt Hancock spoke at the NHS Confederation’s NHS Reset Conference about a new strategy to reduce bureaucracy
The economist Tim Harford often likes to talk about the 2014 tube strike in London. The strike saw two-thirds of the tube network shut down, causing untold disruption.
Some people were hit hard, while others were better prepared. But when normal service was resumed, what was surprising was just how many people changed their commutes forever.
People had found faster, cheaper – or simply better and more enjoyable ways to get to work.
And COVID has been another one of those times. It has been a time of untold tragedy, and we are all willing things to get back more to normal.
But we are also looking at the moment when the people working on our frontline have shown great innovation and imagination and delivered in the most challenging circumstances imaginable.
COVID has put our systems through a real test, giving us a clearer picture of what works well, what doesn’t. Like holding an x-ray up to the light, revealing the care a patient needs.
And as we begin to glimpse through to better times ahead, we must be unafraid to keep treading the new paths we’ve found when the pressure was really on. Those new ways to work, that can lead us to a stronger system and a healthier country I hope in the months and years ahead.
One of these new paths is the way that we’ve been busting bureaucracy throughout this pandemic.
In a telling quote from someone on the frontline, they talked about bureaucracy going out of the window during the peak, saying:
"[COVID] in some ways caused terrible things, but it was also a disruptor. It gave us a once in a lifetime chance to think about what we’re doing and how we can make a difference."
Another colleague told me:
"All of a sudden we could do everything we needed to do, quickly and efficiently – because of COVID. We coped fine without endless meetings and forms."
Now I think this will ring true to many, many people. Now of course, rules and regulations have their place. They done right are the cornerstone of safe, high-quality care.
But as you [NHS Confederation] rightly acknowledge in your ‘NHS Reset report’, when left unchecked, rules and regulations can outgrow their original purpose – and they can stifle innovation and they can damage morale. We have all got examples where we have seen that happen.
I share your aspiration for a “lean, light and more agile approach”.
And learning from the first peak, in July, we set up a call for evidence for Reducing bureaucracy in the health and social care systems.
And I mean the system as a whole. We engaged with staff from on the frontline and spoke with dozens of stakeholder groups.
The response was phenomenal: we heard over 1,000 examples of excess bureaucracy that colleagues are facing every single day.
And today’s publication, Busting bureaucracy, is our response to that.
Now, I know what you might be thinking. You might be thinking: “Matt, I’ve heard this all before.”
And on that you may well be right; and one of things we have done is gone back over the reports in this area of bureaucracy busting for the past 10 years to find recommendations that haven’t been put into action and instead put them into action where we can.
But in the same way our experience through the first peak of COVID has thrown years of theory out of the window because we have got the real practice of what works well when the system is under real pressure, we can draw on people’s honest assessments and make the changes that we need to make.
We have had contributions from over 600 people that have been vital in lifting that x-ray up to the light, and illuminating the daily irritations that make people’s lives harder. Like onerous clearance processes and complicated appraisals, and slow discharges.
And of course the changes we need to make don’t always have to be big. In the pandemic, we’ve seen that little things can make a big difference for instance: letting doctors and nurses communicate with patients securely over WhatsApp, or providing a single login across multiple different computers.
Really simple things that make a big difference.
And I’m determined that we seize this moment and build on the very best of what we have seen over the past 9 months.
The report sets out a wide strategy for how we can finally make real inroads – and it sets out 8 priority areas for action.
I’m not going to go into all 8 today, but I would just like to reflect on a couple.
Data and information
First: the use of data and information.
Data is such a powerful tool in improving how we deliver health and care. With better data, we can make better decisions and free up time for people to care.
When people on the frontline are asked to provide the same data, or similar from different parts of the system ‒ from multiple levels of government with different request for different health and care bodies ‒ it can be really frustrating. I get that.
Not only is duplicating data collection a waste of everyone’s time, it’s a waste of money. And you can sometimes end up with contradictory results.
So setting up data collections which can cost up to £300,000 per trust per collection is an expensive and sometimes draining business.
It’s in everyone’s interest to make this kind of duplication a thing of the past. And our new Data Alliance Partnership will be important in this effort, collecting data once so it can be used multiple times, and providing real challenge to those who may seek to increase the burden of data collection on the frontline.
Crucially, I want that data to flow automatically so it does not require a human intervention and the same information which is used locally to manage a ward or a hospital, can then be properly and carefully, safely and ethically shared.
That brings me onto the second point: the safe and ethical sharing of data offers many more opportunities for us to work together better as a system.
For instance, for responding to COVID we have brought together a single front door for data which ties together the work done in Public Health England, NHS digital, in trusts across the country and of course in NHS Test and Trace to bring together the data which is needed to both manage the virus and the pandemic, and to make sure the burden is lower than what it would otherwise have been with these different organisations involved.
It has been a formative lesson in just what is possible with better data collection.
Improved day-to-day staff processes
Next we want to simplify a whole load of staff processes. For instance, the process for registering overseas doctors.
Because right now specialist doctors including GPs from outside the UK have to submit up to 1,000 pages of evidence.
That’s clearly not the kind of welcome we should be giving somebody who want to come and work in our NHS. Especially when they come from a part of the world where the quality of the qualifications is incredibly high, as it is here.
So we’re working with the GMC to streamline the legislation which dictates the process for assessing a doctor’s knowledge, experience and skills.
But we have to keep busting bureaucracy for those already in the system too.
From last month, NHSE&I ‒ together with the Academy of Medical Royal Colleges, the GMC and the BMA ‒ introduced a new format for staff appraisals.
It takes around 30 minutes, down from 3 to 5 hours previously. These appraisals will not only be quicker, but more useful for professional development too. Putting an end to lengthy box-ticking exercises while I hope encouraging more meaningful verbal contributions.
These are just a couple examples from our priority areas. We also have new proposals on:
• proportionate and intelligent regulation
• more flexible procurement
• a complete review of GP bureaucracy
• greater digitisation of services
• broader culture change that’s needed at a national and local level, learning the lessons from what happened during the peak
And today’s ‘Busting bureaucracy’ publication ‒ and the very real steps that will come from it ‒ are not the limit of our ambition.
I want to embed all of this – and more – for the long term. To build on our commitment to make health and care integration a reality and, where we can, remove the legal barriers that prevent our systems from working together as well as they might, giving us a legal door-stop that prevents us from slipping back into the silos and habits of the past.
While we look to the future – and all that will be possible in the years to come ‒ I hope it will not be too long before we are engaged in another whole system effort, working together, on the potential roll-out of a safe and effective vaccine.
We should be under no illusions that this will be a massive operation, the likes of which this country hasn’t seen.
But I have no doubt that ‒ by working together and embracing the changes we’ve already made ‒ we will overcome the challenges ahead.
It will be a huge task for the NHS and I know the NHS is up to it.
I want to thank in advance everybody for their hard work and dedication this winter, so much work has already gone into this effort.
And I am confident it will not just be a singular moment of coming together, but another milestone in the incredible ways that we can work together.
An example of how we can continue to tread boldly on the new paths we’ve found towards a stronger system and a healthier country where we can work together for the people who we serve.