The NHS has faced some difficult moments over recent years which combined with a major reorganisation and real financial challenges create an aura of doubt over its future which the current political atmosphere is feeding on. I have just spent four weeks lying on my back. This gives some time for reflection and the hope that underneath all this doom and gloom there is more than just a glimmer of hope.
The announcement of Manchester as a quasi-autonomous region in the NHS closely followed by the naming of 29 ‘vanguard’ areas where local services will be given the freedom to create the service structures which suit their needs are being credited as the first big result of Simon Stevens arrival as Chief Executive of NHS England. This is the first dusting of common sense action at a major strategic level in the NHS for donkey’s years. If it is Simon Stevens arrival into post less than a year ago that triggered this we should cheer loudly.
It is a striking contrast with the high value but largely secretive attempts to put swathes of the NHS into private sector control. Nothing that has been announced in the last month could not have been done before the major changes which the NHS has been forced through. They all rely on innovation in the publc sector. Four years have been wasted. Or have they? I think they have shown us some key indicators for the future.
- the previous regime at the most senior levels was not capable of committing to such huge challenges for whatever reasons
- the political agenda created diversions based on trivial dogma which we can now see will be disastrous if they are allowed to proceed
- Stafford was not an isolated incident and what happened there (and in similar hospitals) is connected to that leadership issue
Lets look at that previous regime from another angle. Stafford looms large in that picture. The recent condemnation of NHS complaints handling was long overdue and still requires action. The ‘disciplinary’ actions taken against whistleblowers – many probably illegally – needs explanation. The stories of bullying at various levels and the resulting waste of talent and opportunity that involved also need unravelling. The sad postscript is that those whistleblowers and victims of bullying probably include many real innovators the NHS now needs. For ten years the senior management of the NHS ignored the issues. We can suspect that it did so because that was its own management style, dictated from the top.
Whatever the truth, and no doubt someone will write it up in due course, we seem to be moving forward at long last. It may seem like four years wasted but if the political and executive arms of the NHS were frozen into incapability by the inertia they had built up and by the sheer scale of the politically driven unnecessary change they faced, revitalising them with new leadership and fresh ideas can only be beneficial.
The big issue to learn from is the foolish experiment of Hinchingbroke Hospital. We can see now that it was doomed from day one. Some people said so at the time but the evidence is now inarguable. Merging private sector management, the frontline of patient care, profit targets and the NHS financial system was never going to work.
Bringing in private sector expertise in focused areas can work, especially when you are developing a new service. The provision of PET/CT scanning in the NHS has been privatised for five years and the new ten year contract will go to one of the two previous providers. However this time the contractor will be working closely with an NHS provider, the Christie Hospital, whose role will be standards, skills and knowledge at a national level to support the provision and operation of equipment in cancer centres. It is a clean focus, few distractions. Is this a model to learn from?
The Guardian’s revelation this week that all cancer and end of life care in Staffordshire is to be outsourced to one private sector contractor looks like the lessons of Hinchingbroke are to be ignored. Front line care, quality services and profit hived off from local budgets has no ring of viability to it. By contrast the devolution of Manchester looks chaotic but such is the will to make it work in the public sector it stands a decent chance of success, though no doubt it will be a turbulent road.
So my weeks of enforced rest have arrived at two conclusions.
There are areas where some degree of privatisation will work. They need carefull analysis and planning. Front-line responsibility for patient care is not among the areas where it will work. There is a direct line betwen public money and patient care which should not be broken. I am also struck by the fact that the PET/CT contract decision involved patient representatives and that the contractor Alliance Medical is taking that message on board too.
But the second conclusion is possibly more important. Innovation in delivering NHS services is not dependent on private sector involvement. The ideas and the will are there in the local NHS, all they need is the freedom to demonstrate their viability. The 29 vanguard projects were chosen from over 260 bids, hopefully they are the first of many which will be the engine of change.