After a suitable period of frontline visits, stakeholder roundtables and careful reflection, Sajid Javid is now ready to share his vision of the future of our health and care system. It's a key moment. An insight into what matters most to him. A future reform roadmap from the sector's political leader. What do frontline leaders want to hear?
Key will be explicit recognition of the context the service faces. After a decade of the longest and deepest financial squeeze in its history, the health and care sector was already under significant pressure before COVID-19 hit. The pandemic has created an additional set of challenges. Record care backlogs across a range of services including mental health and community services. An even more stretched and tired workforce. And an unstable urgent and emergency care pathway.
Despite the challenges, there are exciting opportunities. Harnessing digital technology to improve outcomes. 21st century personalised medicine. A much greater emphasis on prevention and tackling the determinants of ill health. Investing in whole population management and reducing health inequalities. Integrating services across health and care. Developing and supporting primary care to operate sustainably at scale. The chance, via the Messenger Review, to strengthen NHS leadership. And the pandemic has shown the NHS can adapt with flexibility and a speed of change few thought possible. Expanding capacity. Rapidly and flexibly redeploying staff. Collaborating to create innovative solutions to wicked problems like speeding up discharges and supporting patients to move treatment to where spare capacity is available.
The need for improved workforce planning for health and care has never been clearer.
But trust leaders will be looking for clear acknowledgement that workforce shortages – currently their biggest concern – will inevitably act as a constraint on how fast and effectively we can build on those achievements and take advantage of these new opportunities. The need for improved workforce planning for health and care has never been clearer. Trust leaders will be looking for a coherent vision that supports them to address the significant day to day operational challenges they face and, at the same time, deliver much needed transformation. And that, taken as a whole, the task they are set, however stretching, will be deliverable.
Frontline leaders will also want to see the health and social care secretary root his vision firmly in the bill currently going through Parliament, taking full advantage of the potential offered by system working through integrated care systems (ICSs) as well as through provider collaboration and place. He will need to address concerns that he is about to embark on a new round of radical reform that sidelines, or moves beyond, ICSs before we have even created them as statutory entities, let alone got them fully up and running. And that his vision aligns with the NHS long-term plan, due for a refresh this summer. Given that both the bill and the NHS Long Term Plan were shaped by his predecessor, trust leaders will want to see appropriate continuity in his vision.
Frontline leaders will also be listening carefully to the tone Javid adopts in his speech, not just the content.
Frontline leaders will also be listening carefully to the tone Javid adopts in his speech, not just the content. There is overwhelming public support for the key concepts underpinning the NHS. Care provided free at the point of use based on clinical need not ability to pay, funded by tax revenue. But some of the usual suspects in the national media and the Conservative Party have been using the NHS' current, understandable, performance pressures to renew their attack on the service.
Trust leaders are ambitious for their patients. They can see the need for change, transformation and reform. They know that the NHS has to deliver better outcomes for the extra investment the government is now providing. Even though that extra investment just takes us back to the long term, average, real terms, funding growth rate the NHS has received since its foundation in 1948. So they will want the secretary of state to frame his narrative around the strengths the service can build on. And the assets the NHS can bring to address the current challenge. Rather than a finger wagging admonition that what is currently being delivered is simply not good enough.
It is right that our political leaders should challenge and stretch the service. But the NHS works best when its political and operational leaders are aligned in pursuit of a common, deliverable, strategy and plan. And when the service's achievements are recognised, rather than ignored. Tomorrow's speech provides a perfect opportunity for Javid to provide a vision around which we can all unite.
This blog was first published by HSJ.