Alumni story / Governing for transformation

Just as it seemed that that the future prospects for the NHS could not be more opaque, along came a snap election. Five weeks from now we will have a ‘new’ government and (quite possibly) a new health secretary. Even if the ‘party’ remains the same, there may well be very different  mood music to which those who lead the NHS (both nationally and locally) will be required to dance – its beat more urgent and insistent. The ‘collective unconscious’ of the electorates of the west seems drawn, like a moth to a candle flame, by the promise of ‘strong and decisive’ leadership.

An accelerative pace of change characterises the 21st century. Even the shelf life of nostalgia has foreshortened. I find myself thinking back fondly to January 2017. Then it seemed that sustainability and transformation plans (STPs) really were the only game in town (even though the ever shifting rules of a post-modern game seemed to be a crucial, and often baffling, element of the game itself). 

Now, Labour, were it to assume power, is explicitly committed to review every STP, while the support STPs (and their author) are likely to enjoy from a new Conservative administration and a prime minister with a tightened grip on power are open to question. 

Inevitably, the long shadow of Brexit will continue to dominate the UK’s legislative landscape. It may take months, but the new government’s health and social care priorities for England will be translated into a new blizzard of policy imperatives and directives. Some key NHS leaders will soon be gone, but a few things remain certain. 

The demand pressures upon the NHS and social care will not spontaneously remit - demographic change will drive up demand, year on year, and at an accelerative rate, for the next 25 years. 

Funding has not and will not keep pace and the cumulative impact of cost pressures will become ever more threatening. If we keep doing ‘more of the same’ then waiting lists will be counted in millions and ever more NHS providers will be trapped in a downward spiral of diminishing quality and burgeoning deficit. If the trend of the last two months continues unabated, ‘special measures’ will become the new provider norm.

This is a florid symptom of a politically and structurally iatrogenic long-term condition – a health and social care system that is neither adequately funded nor fit for 21st century purpose. If the NHS is not to implode and be superseded by a twin-tier private insurance plus public safety net system, the need for profound and whole system (not piecemeal, organisation-by-organisation) transformation remains paramount. If STPs are not to be the rubric for change, then a new one will need urgently to evolve or to be imposed.

We must not become paralysed by uncertainty. Purdah provides a brief ‘pause for thought’. Not for inaction. Later this month the HFMA Provider Finance Faculty holds one of its regular director forums. Those who govern NHS bodies must use opportunities such as this to reflect collectively upon the lessons of the distant and immediate past. And they should look to work collaboratively to map agile, flexible and collective ways forward that protect the patients and communities that the NHS has served with distinction for the last 70 years. 

Paul is speaking at the HFMA Provider Finance directors forum on 18 May at Rochester Row in London. He will take part in a session looking at STPs and governance.