We live in unprecedented times. Every day we hear that the NHS and other public sector settings face a dramatically different future, with less resources and a compelling need to do things differently. Over the next five years as budgets shrink there is, we are told, a once in a generation chance to reinvent the health system to deliver care differently, more effectively and more efficiently.
In 2002 Derek Wanless set out a vision for a very different health system, one whereby individuals are in control of their own health needs, a system designed to keep people well rather than manage illness as it arises. Although published eight years ago there has been little genuine progress towards achieving this. Now there is a demand to radically reduce costs in the health system, while meeting the agenda to deliver high quality services, there is a real opportunity to achieve the Wanless vision. The publication of the Department of Health’s NHS 2010-2015: From Good to Great. Preventative, People Centred, Productive provides a framework for a Wanless style NHS transformation.
So, what place does nursing have in all this and how are nurses to respond? In The Innovator’s Prescription, a treatise on how to get innovative change to happen in healthcare, Clayton Christensen characterises much of what has been innovative social change as “disruptive innovation”. It is a term that refers to those things that have widespread impact, that create disproportionate levels of change. These usually involve a new technology - one that may not be better but is cheaper and works in a very different way to the “old” technology. He cites the mobile phone as a classic example - they undercut the more expensive standard fixed phone by offering a different possibility and, although they were not necessarily better to start with, were a radically different way of communicating that ultimately changed all our lives. Christensen suggests that, once standardised, medical treatments can largely be provided by non-medical practitioners, and long term conditions can be managed well by patients in supported networks. This means doctors and hospitals can preserve their expertise and facilities for conditions that require high order decision making and intervention. Here is an important message for nursing.
‘Develop yourself. Acquire the skills that will free you to manage care pathways without others having to assess, prescribe, make decisions or “permit” what is needed’
Could nurses and nursing interventions be like mobile phones and act as a disruptive technology within the health system, creating change that we haven’t imagined to date? Can nurses invent new low cost service models reaching into communities and people’s homes supported by technology? Can nurses create networks that help people who need care or advice to manage their own care so they need less input from hospitals and clinics? Can nurses mobilise people to better manage care for themselves? Are nurses able to act as disruptive innovators - adopting practices traditionally in the realm of medicine so much so that the NHS is radically altered? If so, we will spearhead potential disruptive innovation - transforming health and healthcare.
Wanless estimated that 20 per cent of the work of doctors, GPs and junior doctors could shift to nurses without compromising quality or safety. It is time we saw a step change in this shift of caring responsibility. Nurses and nursing need to move fast to take on skills such as prescribing, assessment and clinical decision making, alongside the high order skills needed to provide support for self care such as motivational interviewing and coaching, providing psychological therapies and leading service transformation. We need to become vocal champions for the best way to deliver high levels of patient satisfaction as this will, for the first time, carry financial rewards for NHS providers. We need to work as an energised collective doing everything we can to achieve our potential.
As a nurse you need to develop yourself. Acquire the skills that will free you to manage care pathways without others having to assess, prescribe, make decisions or “permit” what is needed for individuals. Remove the barriers to your practice. Be imaginative about what could change to improve quality, reduce waste of precious NHS resources and help people to manage their own care.
Our nursing leaders need to make change happen by being demanding and acting as a single, united and politically effective voice for change. We must tirelessly work to remove the barriers for individual nurses to take responsibility and transform outcomes for individuals. We must create new and different roles for nurses embedded in communities to deliver critical elements of care pathways rather than in monolithic NHS institutions.
Finally, we need to rapidly expand the training of high calibre individuals to lead this agenda - from new entrants to the profession to our leaders of services, not forgetting nurse researchers who develop the knowledge and technologies on which “disruptive” nursing expertise will depend. These are challenging but exciting times - join the mission to deliver our disruptive potential.
Jessica Corner is head of the school of health sciences, University of Southampton