'Small and mighty' NHS Wales helping staff from porters to consultants change healthcare for the better

The NHS in Wales is staffed with people who care, but it often makes headlines for the wrong reasons. While sometimes positive – as in the case of free prescriptions – the public image is often coloured by negative stories of failing health boards and long ambulance waiting times.

Despite being acknowledged as the birthplace of the NHS itself, Wales’ own devolved healthcare system is often seen in a less favourable light than its counterparts in England, Scotland and Northern Ireland. However, Wales is actually a hotbed of experimentation and is leading many innovations in healthcare practice.

The adage of “small and mighty” holds true for the Welsh nation. Healthcare systems the world over face several common challenges in terms of ageing populations with increasingly complex care needs, and growing inequalities between the wealthy and the poor. Wales is no different, but research from the Bevan Commission – a health and care thinktank, hosted and supported by Swansea University – shows that it has many specific advantages in terms of its size and consequent agility.

In Wales, it is possible to get an entire profession or care pathway in a room to work on a few vital innovation and transformation projects that can unlock people’s skills and resources.

Size matters

I have been working with the Bevan Commission for several years to measure and evaluate the impact of healthcare innovation through their “Bevan exemplars” scheme. The scheme seems deceptively simple: each year, a cohort of 30–40 NHS professionals in Wales are given mentoring, training and support to try out and test their own expert ideas, in their own clinical or care settings.

Anyone employed by NHS Wales can apply, and the scheme has seen porters, nurses, physiotherapists and surgeons join its ranks. Ideas range from using future-facing technology to improve patient experiences (such as Virtual Reality distraction therapy for cancer patients), to environmentally-friendly ways to reuse hospital waste (for example, recycling single-use plastic into valuable polypropylene blocks). Previous projects undertaken by the first cohort of exemplars have radically transformed palliative care processes and improved all aspects of healthcare delivery.

Many in the NHS maintain that “all change fails” within the health service. Although this may seem like a gloomy prediction, previous research from The King’s Fund has indeed found that 70% of all change projects/programmes in NHS England fail. Through the Bevan scheme, NHS professionals in Wales are tasked with thinking differently and finding new, innovative ways of doing things. They challenge existing practices and systems while learning how to deliver better health and care more effectively.

Trying out and testing innovation entails significant risk which could expose these NHS professionals (and their radical ideas) to organisational resistance to change and possible failure. However, we have achieved an 80% success rate on the projects, with potential for rolling out local and regional projects to an “all Wales” scale.

Each project also generates, on average, £196,000 in economic benefits (which could include savings on staff time or resources) for the healthcare employer that sponsors the professional. And 32% of the experimental projects developed were suitable for immediate scale up or adoption.

The new radicals

So why does this Welsh programme for healthcare innovation succeed where others (with equally honourable intentions) do not? The size of Wales and the potential for networking within it may provide one possible explanation. But my interviews with the NHS professionals who have taken part in the scheme also point to hands-on training, new skills and the support of a credible, external organisation.

This may all sound very rosy for healthcare innovation in Wales, but the challenge will be in making change stick – and spread. Many successful healthcare innovation projects falter when trying to scale up from the original, small team to adoption at a national scale, for all sorts of reasons.

I have made several recommendations for improving scaling up and expansion of the scheme, such as integrating NHS employers with professional bodies, establishing spin out businesses and better connections between NHS Wales organisations.

If Wales can master the expansion and reach of its innovative ideas, it really could become a driving force for change in healthcare in the UK and beyond. The signs are already there in terms of transforming services and joining up healthcare to create a system that is, once again, the envy of the world.