So, almost two and half years after I joined the cost recovery programme, I am moving on to a new role. As I think through my handover, I have been reflecting on the challenge we were given then - to change attitudes and behaviours towards charging visitors and temporary migrants for the NHS treatment they receive - how we approached making the case for change and the significant achievements to date.
1. Making a case for change
The independent research undertaken by Prederi better quantified the income potential and enabled us to build a persuasive case for priority changes.
2. Giving the issue the status of a national programme
Creating a programme allowed investment of priority, money and people, and enabled us to secure attention and interest from senior leaders in government and in the NHS.
3. Managing the communications message
Recognising early that the success of implementation relied on first impressions taken from the message and that this was about fairness and sustainability not immigration control and any restriction of access.
4. Investing in relationships
Identifying the lack of direct levers, and building strong partnerships for policy development and delivery within government, with stakeholders in secondary and primary care, vulnerable group reps, and with overseas visitors, trusts, commissioners and GP practices.
5. Financial incentives
Appreciating that extra resource would be needed to support behaviour change and making that available.
6. Thinking proactively about equality
Engaging experts and thinking about how changes could impact positively and negatively, and adjusting the policy and guidance to mitigate.
7. Getting on with it
Focusing on delivery with pace. Getting on the train and taking the priority to the NHS with trust and CCG visits, developing and paying for the Cost Recovery Support team.
8. Taking a staged approach
Not doing everything at once and starting with the easiest and biggest impact changes first.
9. Thinking ahead to business as usual
Not cracked yet, but making sure that changes stick and become business as usual.
10. Evaluating and reviewing
Commissioning independent evaluation and using it along the way to reflect on progress and refine our focus.
There is still a way to go, but I am immensely proud of the changes we have collectively made. Keep going!