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Siloed, unsupported and hindered – the reality of innovation in the NHS and social care

During 2023, we set up a series of online workshops to support a peer group of technology innovators. We explored how staff and leaders, providers and suppliers were innovating and navigating digital transformation in the NHS and social care. Over the course of four workshops we brought together 100 people, creating a space in which they could connect and share experiences of innovation and transformation in a health and care system that is under so much pressure. Here are some reflections on what was shared.

Despite the challenges facing the health and care system, innovators are still very passionate about their work and driven to create and use the best tools to improve care for people, staff and the system. Throughout our conversations, the energy and enthusiasm for technology to potentially help meet the challenges of today was inspiring. But we noticed how quickly, and how often, frustrations bubbled to the surface. Our discussions would quickly turn from what is possible to the reality of how hard it is to innovate in the NHS and social care. This made us wonder: how much of this is driven by resistance, fear or uninterest to change?

Innovators have a shared sense of frustration – not only is the health and care system not as good as it could be, it is also a struggle to innovate, and making change happen often feels unnecessarily difficult. A clear message that emerged from the workshops was that innovation happens not because it is supported by the system but in spite of it, due to the energy and drive of enthusiastic individuals.

When this lack of headroom is combined with a culture of risk aversion, it makes it almost impossible to innovate and change.

Innovators shared reflections on how the system isn’t supportive of innovation; it is a significant effort to create digital services in a system that is resistant to change. These difficulties span current everyday workload pressures, culture, organisational structure and leadership. Innovators see how their colleagues have no headroom and that an ‘everyone in the trenches’ mentality perpetuates a culture in which there is no space to do things differently. When this lack of headroom is combined with a culture of risk aversion, it makes it almost impossible to innovate and change.

 Another cultural challenge raised was the drive for perfect solutions, but many agreed we need to redefine success and recognise that ‘sometimes success isn’t saying this is the perfect approach but rather this is less bad than what we’ve currently got’. We heard how there are a lot of good ideas and often these ideas are right; however, the lack of leadership support combined with organisational silos mean that the people trying to innovate don’t have the support of an effective implementation plan, and knowledge is fragmented across different levels of the system.

This lack of inclusive shared spaces to enable effective working prevents collaboration, discussion, support and learning, which in turn drastically reduces the potential for system-based innovation and change.

Innovators across different professions, parts of the system, and from providers or suppliers all agreed that there is a real sense of separation and siloed innovation. The spaces created for, and dedicated to, innovators (eg, forums, meetings and chat groups) separate NHS, social care and commercial suppliers, and often even different professions. This lack of inclusive shared spaces to enable effective working prevents collaboration, discussion, support and learning, which in turn drastically reduces the potential for system-based innovation and change. One person commented that innovation and transformation are ‘a team sport, nobody can do it well on their own’. An example given was the NHS Futures platform, which even by the name creates in and out groups. So, we’re left wondering what drives and perpetuates the silos – power dynamics, distrust or something else? There’s an important role for leadership to play here in creating new spaces and improving existing ones to be inclusive, enabling diverse groups to come together to work on shared goals.

Reflecting on the workshops, it is no surprise then that innovation happens in pockets and that the NHS and social care have a reputation of being slow to innovate. Examples of innovation are often the result of hard-won success by a group of individuals who feel like they’re battling against the system. But it doesn’t have to be this way. Staff knowledge, expertise and passion to improve services is an untapped well of innovation energy. But the system makes innovation much harder than it should, and could, be. Is the current centralised approach to innovation incompatible with how innovation actually thrives – through permissive environments and enabled people? To have an NHS and social care that is able to innovate and thrive means changing how we make change happen.

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