Our third interview is with Helen Buckingham, Director of Strategy and Operations at the Nuffield Trust. Helen took on this role in June 2018, having joined the Nuffield Trust in 2017 as a Senior Fellow, working on a range of health policy issues. She has 25 years’ experience in NHS roles, including senior roles in national bodies, as well as in both commissioner and provider organisations. A finance professional by background, Helen’s past roles include Director of Strategy and Organisational Development in a mental health trust; PCT Chief Executive; Chief of Staff at Monitor; and most recently Director of Corporate Affairs at NHS Improvement.

What’s going to be headline news in the health world in 2018? 

It’s hardly a secret that money is very tight this year, or that there are very significant workforce challenges. Headlines will come from the ways in which national and local systems respond to these pressures. I’m hoping for good news – innovative approaches and collaborative working which looks beyond the boundaries of the traditional health system. I know that exists in places. I fear however that we will also continue in some places to see the results of failure to recognise the need to change our attitudes and our actions if we are to change our outcomes.

You have recently written about the changing commissioning landscape. Will reshaping services locally via Integrated Care Systems lead to a more efficient service for patients? 

I feel very strongly that integration is a state of mind, not a structural construct. Services run by the same organisation can be ‘dis-integrated’. Where leaders, clinicians and, crucially, middle managers really want to work together to ensure that the person receiving services has a seamless experience, that can happen with or without a formal change in structures or relationships. So ICSs will make a real difference – if we really work at it, not by magic.

How important is engaging with patients and staff to helping tackle the challenges faced by the ICSs? 

Unbelievably important. Organisations don’t do things, people do. If we don’t engage with the people who use services and the people who actually do the hands on delivery of care, how on earth can we know that we are doing the right thing? And it’s important to do it on their terms, not ours. We have a bad habit in the service of ‘consulting’ when we want to change something, rather than listening to get a sense of what people really value and why – and what they’d like to see change. It’s a two way thing of course – it’s important that we can set out clinical, and indeed financial, reasons for change – but if we do that in the context of a strong relationship and an ongoing conversation, we’re much more likely to reach a mutually agreeable outcome.

Do you think that the Accelerated Access Collaborative will be successful in driving innovation and what will the main challenges be? 

It can be – but that’s not the same as saying it will be. See our report on the subject for more detail.

How long do you think Simon Stevens will stay on for? And any ideas who might succeed him?

No comment! Except to say that he has both a tough job, and perhaps one of the most important ones in the country, so when it does come to it the succession plan is not an easy one.

How well do you think patient groups, industry or politicians communicate to the public about health? 

Health, or healthcare? They’re not the same thing. I think some headway is being made in raising awareness of health issues – in particular, in recent years, mental health issues – and how we might be able to improve our own wellbeing. That is possibly not so much thanks to professionals or to special interest groups, but may have more to do with the rise in use of social media and the willingness of individuals, especially high profile individuals, to share their experiences. We still have some challenges though when it comes to helping people to understand healthcare, not least because often even those of us steeped in the service don’t really understand how it all joins up. It is often striking to hear the experiences of how health professionals and managers, even very senior ones, navigating the systems they themselves work in has changed their attitude to how others experience them. We had a terrific example of this from a breast surgeon and a Director of Nursing at our Summit earlier this year.

What learnings do you take from your background in finance and apply to your work in health policy?

Most useful skills? Well, with apologies to my colleagues still in the profession, I can’t say I miss the balance sheets… but having an understanding of them is quite useful. It’s also quite handy to understand how costs work in large organisations. I used to have this quote from Benjamin Franklin as my screensaver: “The use of money is all the advantage there is in having it.” It’s important to me that we understand how we are using the resources which are allotted to us by taxpayers, and in particular what the return is on that investment, and what the opportunity costs might be. An investment might be in cash or in kind, an ROI might have a financial value or a social value attached to it, but whatever we are doing we should be able to say what we expect to put into a particular piece of work, what we expect to get from it, and how we’ll measure that. And why that piece of work is a better investment than the alternatives – or how we’ll test whether it is.

What are you most looking forward to writing about in 2018? 

I have an increasing interest in what stops people doing the things they know they should be doing. For example, we’ve been espousing integration for as long as I have been working in health and care – what gets in the way? I’m also interested – and there’s probably a relationship with that question here – in how the different ‘tribes’ which exist in health, including the ‘patient’ and ‘public’ tribes, interact with each other, and what we might be able to do to get the most value from the terrific diversity we have in health.

Do you have a favourite book on health or medicine, either fiction or non-fiction? 

I have extremely broad reading tastes and so no particular favourite book. A couple which made me stop and think have been:

  • Nick Timmins, The Five Giants (revised 2017) – A superb examination of the genesis of the welfare state and its development through to the present day, really connecting policy and practice.
  • Tim Smit, Eden (updated 2016) – Possibly unintentionally, an excellent treatise on leadership and community engagement as well as a fascinating account of the development of the Eden Project.

And I get a lot of great reading ideas from my Twitter feed too; I think it’s important to get outside your bubble a bit.

If you could mandate one single change to the health care system, what would it be? 

Mandating change doesn’t work. We need to create the conditions in which change can flourish.