‘The NHS doesn’t have a clear approach to how you do change'

The vision is good, but that’s never been the big problem. What the health service is going to find hard about the fundamental changes envisaged in the NHS Five Year Forward View, says Nigel Edwards, is getting its act together to make them.

“The question we really struggle with is the change management – how do you do it?” says the chief executive of the Nuffield Trust healthcare thinktank. “It’s the weakness of the NHS generally. It doesn’t have a very clear approach to how you do change.”

Edwards is talking ahead of the Nuffield Trust’s annual health policy summit, where the great and good of the health and social care world gather to chew over the challenges they face. This year, much of the focus will inevitably be on the forward view, unveiled to broad acclaim by the NHS England chief executive, Simon Stevens, towards the end of 2014. It charts a path ahead for the NHS that will largely hold good, whatever the outcome of the looming general election.

The report sets out a deal by which the NHS will deliver change to create a sustainable healthcare system, with greater emphasis on prevention, public health, patient control and service integration, in return for the bridging of an anticipated £8bn funding gap before savings from those reforms kick in. Stevens says: “We are at a pivotal moment: either we move to something different or we begin to see services run into the sand.”

Edwards, who acted as an informal adviser to Stevens in preparation of the report, has seen reforms come and go from his perspective as a long-time expert observer of the health service, including 11 years as policy director of the NHS Confederation. Many have been enthused about; few have been embedded.

“The NHS is very good at writing bids, it’s fantastic at it,” he says, referring to the 268 expressions of interest in establishing the first “new models of care” under the forward view. “But execution has always been a problem. It’s like eight-year-olds playing football: everyone chases the ball.”

Players with a more considered approach to the change game think about issues like professional and cultural differences within health and social care organisations – differences in attitude towards risk, for instance – and about ensuring buy-in from key figures such as directors of finance. “It’s often largely about relationships, not technical issues,” says Edwards. “Working through all that has a lapse component that probably can’t be shortened that much.”

Stevens’s insistence on scale and pace for the new models of care programme – he wants to see “rapid progress” - raises obvious questions about timing; but he does appear to be addressing the relationships issue, having spoken of seeking to involve health and care partner agencies in deciding if local bids should go ahead.

Both Stevens and the health secretary, Jeremy Hunt, will be among speakers at the summit, where a second theme will be the role of technology in improving quality and cost-effectiveness of care. Nuffield is conducting international research on this, with findings expected towards the end of the year, but Edwards says: “There’s a lot of optimism about the scope for technology to improve workforce productivity, but we suspect it may be harder and there may not be quite as much scope as the techno-optimists seem to think.”

The NHS is often ridiculed for being technologically backward – Hunt himself gets laughs in speeches by talking about faxes still being used - but Edwards says there is little understanding of why this should be so. One issue could be that the service has often been saddled with “clunky” systems that are far from user-friendly. Another could be that when new systems are added, old ones typically stay in place regardless.

“There is this dark side to technology in healthcare,” he says. “You do need to have the substitution, otherwise you are having an additive effect on cost.”

The summit’s third theme involves throwing open the doors of the event to “engaged communities”, very much in the spirit of the forward view’s focus on fostering patient control. Attendees will learn about best practice in Sweden and the Netherlands and will hear from UK groups such as Altogether Better, which promotes community health champions, and the Royal Voluntary Service, which runs volunteer schemes to support the care of older people.

It feels much like a symbolic opening of the exclusive summit club to non-members. Edwards, borrowing a metaphor from Joanne Shaw, who chaired the former NHS Direct, likens it rather to the NHS “cathedral” meeting the “bazaar” of innovative, entrepreneurial groups giving voice to the patient. “People in the cathedral often find it very hard to come to terms with the world of the bazaar,” he says. “So we’re having some of the people from the bazaar in the cathedral.”

The Guardian Healthcare Professionals Network is a digital media partner of the Nuffield Trust Health Policy Summit on 26 and 27 February. The network will be carrying live coverage throughout both days.

• This article was amended on 25 February 2015. The headline in an earlier version used a quote from Simon Stevens referred to in the interview, rather than a quote from Nigel Edwards.