In the weeks and days before any incumbent Chancellor leaves No. 11, red box held aloft for the waiting press, some people will have already attempted to predict the likely impact and accordingly take action. Smokers might be tempted to buy a few extra packets of cigarettes. Wine and whiskey drinkers might be persuaded to top up their cellars and drinks cabinets. Many of us will make sure the petrol tank is filled in a timely manner and certainly prior to the midnight price increase.
These people are behaving in a way that can be considered economically rational. Why pay more for goods and services tomorrow when they can be purchased today when additional savings can be made?
Generally such a phenomenon tends only to apply to the consumers of goods. For the suppliers it is a different story. Shopkeepers can hardly raise the cost of cigarettes, wine merchants don’t hike prices and forecourt signs do not start rolling forward petrol prices in anticipation of what might potentially be announced. And what of the ultimate supplier, the supplier of tax revenues – the UK tax payer? We might all become understandably irritated if our pay-packets felt lighter before a rise in income tax had been announced.
In the context of budgets or spending reviews the initiative seems to lie with the consumer of goods and services. Or at least those consumers who have the vision to predict what is likely to happen. However that it is not to say that providers and suppliers cannot take action when faced with an uncertain financial future. It’s just that not that many do.
For the NHS the forthcoming Comprehensive Spending Review (CSR) is a case in point. Arguably this spending review is more eagerly awaited than any other Budget in history. But given the uncertainty of what it could contain anyone in the NHS could be forgiven for waiting to be told what to do. Like the proverbial shopkeeper, the NHS is waiting for direction, price tags at the ready.
But in the same way that there will always be a certain group of smokers and drinkers who take action ahead of any predicted changes there are parts of the NHS that are acting ahead of the CSR. They are taking the initiative; they are innovating and, despite a lack of clarity about what their organisation will be like in the future at the end of the process or even if they will have jobs, they are taking action.
Some of the actions have been predictable and necessary - a knee-jerk turning-off of taps. Vacant posts remain unfilled. Contractors have been let go part way through projects. Spending on business advisors has been reduced. New investments have been halted or paused as tactical cost savings schemes are being chased up and down the country.
Although predictable and arguably necessary this temporary turning off of the taps will not deliver the shift in spending required. We need to be clear about something: the NHS does not need to save £20 Billion from the NHS budget. It needs to move it. It requires a fundamental refocus on changing needs, evolving technologies and new patterns of provision and behaviour.
Fortunately there are people in the NHS who are already leading at a local level. They are the people who are already shaping the organisations that will be needed to meet the changing needs of the UK population. Admirably these individuals and organisations are harnessing unique opportunities that have a tendency to occur only in uncertain and challenging times. They prove that in the midst of uncertainty and challenge surprising, truly innovative change can happen.
One such example is employing the insights from social sciences such as social psychology and behavioural economics. Or to put it in terms that are meaningful – how to deliver large scale positive changes by applying low cost interventions or ‘nudges’. Earlier this month a Primary Care Trust in the East of England and a large teaching Hospital in Central England launched programmes to introduce the lessons and evidence from Social Psychology into the management of their services. Two large GP practices are looking at how they can influence patients to turn up for their booked appointments, or at the very least give notice that they won’t be there.
This may seem like a small change but the benefits are potentially massive. The King’s Fund estimates that patient’s not attending booked appointments costs the NHS £600m per year. This is a large number in itself but non attendance is just the beginning. The ideas being incubated in these innovative organisations can not only be spread to other NHS organisations, they can also be employed in other areas to help ensuring patients with long term conditions follow the treatments plans they have agreed with their clinicians, encouraging people to take the medicines they have been prescribed, nudging people to use the appropriate service at the right time and persuading people to take greater responsibility for their own health. Ironically by understanding the behaviour of consumers such as smokers and drinkers and how they react and behave in live markets could help shape the very interventions that will reduce the pressures on the services that seek to help them and others.
As well as patient behaviour interventions work being done in many parts of the country to establish new commercially focused and intelligence led support units for the emerging GP Commissioners. Bringing together an understanding of how people do change and behave with an infrastructure of services to support such change seems like a hugely important component of the next phase of our NHS.
This is real innovation and at the moment it is local. Real innovation tends to be local. A big opportunity exists now to spread this innovation virally across all NHS networks.