What does a ‘good’ health service look like?

I recently worked with a group developing a New Model of Care, discussing what ‘good’ looks like. “How will NHS England know we are good at what we do?” was the main topic of the debate, to which I added “how will the patients and wider stakeholders, which includes all service providers e.g. general practice, know you are good at what you do?”  

Now, before you all reach for the reply button to the email and remind me of the raft of measurements within the recent planning guidance, along with every other measure available, for me this is a more fundamental question and there is a simple answer.  

I believe the New Models of Care will know what good looks like when they can get high quality care, delivered consistently by all providers (across the system) working to agreed standards, pathways and thresholds. When everyone knows that no matter where patients choose to access the system, they will be placed in the most appropriate setting for the level of care they require, and will receive one high quality service without unwarranted variation. At that point, everyone will know what good looks like.  

To get there requires all those involved to ensure the change work they undertake leads towards the implementation of the agreed outcomes. This includes embedding the culture that goes with that through a series of behavioural changes, which then ensures they work together to deliver their strategy.  

They will, of course, need fantastic engagement across the entire health economy. Patients, carers and the wider public, the voluntary sector, general practice, hospitals, community services, mental health trusts, ambulance trusts; basically all stakeholders and providers who believe they have a part to play in designing and then delivering a system wide approach. 

This requires the step of those in leadership roles being prepared to be challenged. Equally, stakeholders need to feel they can appropriately contest leaders, be heard, have concerns addressed openly, and ultimately the decisions reached genuinely include all involved, who then feel empowered to act.  

The time has come for a new approach, one that properly, genuinely and meaningfully engages everyone who wants to be engaged, whether it’s 9, 90, 900 or 9000, so that the need for change is understood and the plans put forward, no matter how challenging they may be, will be properly owned and then implemented.  

By allowing people to self-select their engagement, you ensure there is nothing done to them from the top down.  If you stop for a moment and consider that the current top down model is based on a once successful management approach, where a parallel organisation exists – the steering group or subcommittee approach – with the chosen few making decisions for the many, and then only engaging with stakeholders once the direction or initial plans have been created, you will understand what I am driving it. While this process once worked, in today’s environment it is no longer fit for purpose, as it builds resistance at every step, and change fails. 

If people aren’t involved from the beginning, they are more likely to resist and obstruct change, even when the ideas are good. People recognise that they are being sold something rather than being asked for their input from the start.  

Whilst challenging, this ensures that the vision created is one that has been developed by all those who have a role to play, whatever that role, leading to buy-in and ownership of what you create as a community for care and bringing about a critical mass for change.   

When you reach that point, where everyone has self-selected their engagement you will have built a community for change that owns the process and the project(s). From there anything is possible within a health economy, and you will know what good looks like.  


Scott McKenzie is director at Scott McKenzie Consultancy.