Comment / Dear prime minister...

In a message for the country’s newly elected leader, Paul Assinder offers some pointers for the governing challenge ahead.

May I be among the first to congratulate you on your victory. Clear and consistent leadership in the most challenging period in our 60-year history is vital to those of us charged with steering public services in the years ahead. One of the biggest challenges you face is to reduce our fiscal deficit while driving further improvement in public services, as the demographic and consumerist demands of the post-war baby boomer generation begin to bite.

You and your cabinet colleagues may wish to ponder for a moment upon the messages apparently transmitted by the British public; that extreme times require organisational loyalties to be set aside for the greater good. This resonates across the NHS as we must seek to forgo local interests in search of more effective service delivery.

Britain is more than ever a union of four separate home countries, with health one of the key functions determined locally. Very soon, one of those bright sparks from the Treasury will seek to brief you on why the Barnett formula should urgently be reopened. This is really a red herring. We should celebrate the genuine differences in our different systems and accept that each nation is approaching a common challenge from very different starting points, with four different sets of policy levers. In such circumstances, the federal whole will surely be best served drawing lessons of best practice and promoting these across the rest of Britain.

As for the English NHS, you will already be looking to translate manifesto commitments into the departmental plan.  I commend to you an early review of the seminal work by Sir Derek Wanless on NHS funding, or the more recent studies of the King’s Fund and Institute of Fiscal Studies, against which to set the current reduced affordability envelope.

Your commitment to preserving the level of national spending on front-line services is genuinely appreciated by NHS staff. But finance directors are already clear that recession will have a significant impact on real spending power at patient level.

All NHS organisations are committed to delivering productivity improvements so we can build on the access and quality gains of the past two decades. But we need to be clear and honest with the public that cost savings of this size, over this timescale, cannot be delivered solely through the ritual sacrifice of ‘back room’ staff or much maligned NHS managers.

In three years the NHS must be smaller in size, with fewer buildings and staff, including fewer doctors and nurses. But the NHS must also generate increased service outputs with improved health outcomes, if we are to judge the next period a success.

Key questions we must address include:

• If care closer to home and choice are the preferred models of provision, how can we ensure it also costs less, since this appears counter to cost saving policy direction in other sectors of the economy?
• Since the health status of the population is a long-term problem influenced by factors outside direct NHS control, how can we best set aside organisation rivalries for effective multi-agency working?
• How can current and future policy levers incentivise cooperation and efficient service delivery?

NHS finance staff are ready, willing and able to work in the front line to champion the sort of changes in clinical practice necessary. Give us the political ‘air cover’ to do our jobs effectively and we will deliver. I wish you every success.