New Year’s Resolutions for the NHS
I have always been a fan of New Year’s Resolutions, however unsuccessful I have been at keeping them. Sometimes I surprise myself, as I did when I managed in 2011 to run a Marathon, the high spot of my athletics and fundraising careers, while on other occasions I make little progress, despite the good intentions. However, like most things in life it’s better trying than not.
So I will settle down in the next couple of days to pen a few personal resolutions but I also wondered what are the resolutions I would ask the NHS to follow in the coming year.
There is no doubt that it will be a tough year, although, as Simon Stevens and as others have rightly pointed out, a slightly less tough year than it would have been if the NHS had not been given a front loaded injection of extra funding in the first year of the new spending settlement. What might have been impossible is now just challenging.
That challenge involves the NHS simultaneously getting its existing financial (all £2 billion of them) and operational problems under control while making enough tangible progress in developing new models of care to ensure that, when the money becomes less generous again, the system is resilient enough not to fall into the same difficulties in future years. To do so will require skill, courage and some measure of luck. It will also be helped by trying to adhere to some important principles, principles which have not always been at the top of the pile in the recent history of the service.
So, on that basis, I have five resolutions which the NHS should try to follow in 2016.
The first is to put the workforce at the centre of thinking and not treat it as the afterthought which it so often has been in the history of the NHS. This has to be more than just about the costs of agency staffing which is but the symptom of a deeper malaise. As well as pressing issues about numbers we need to devote some time at both a national and local level to rethinking the psychological contract with NHS employees, to considering again how we value the contribution of both clinical and non-clinical staff in providing good care and to thinking hard about the psychological stresses of care giving and what more we can do to engage support the staff on whom we depend totally for good care in the present and new models of care in the future.
The second resolution is to ensure that, at last, mental health takes centre stage in the NHS. 2016 will be an important year with the introduction of the first waiting times targets in mental health, an important statement that mental health problems are of equal importance to those relating to physical health. However this is but the start. The real revolution in thinking comes when we recognise the centrality of mental health and psychological factors at the heart of the experiences of being ill and providing care. If we want a sustainable health service we can no longer afford to treat the body without taking any account of the mind.
The third is to respect completely the management adage that form should follow function. It has been fascinating in the 30 years or so I have worked in or near the NHS to see how readily the service, and those in charge of it, reach for an organisational solution to any problem. It would have been thought that the Lansley reforms would have cured the NHS of that tendency for good and, to some extent, it has created antibodies against structural change. However old habits die hard and much precious senior management and governance time is still spent debating the opportunities or threats of different organisational models and configurations. Accountable Care Organisations are the latest focus but often without any clear idea of what problem they will solve. I would not be alone in thinking that there will not be the same configuration of health care organisations in 2020 as there are today. But let’s make sure that organisational changes stem from genuine changes in models of care and are grounded in genuine local decision making.
The fourth resolution is to be clearer than we have succeeded in being in 2015 about our narrative of transformation. The 5 Year Forward View has retained its usefulness as a signpost for change but it is not a roadmap. While improving efficiency and reducing variation between providers is important and has its place in releasing savings it must not be allowed to distract from a bigger story about changing the fundamental model of care to put the community and not the hospital at the centre of provision in a way, which takes full account of the psychological and social needs as well as the medical needs of patients. Those of us working in mental health have been on that journey and known how difficult it can be. The NHS, as a whole, needs to know that is what we are about and the public need to know that it will involve closing or changing the use of some hospitals.
The fifth resolution is to focus more on prevention. While it is worrying to see the impact of cuts on local government spending on public health work just at the time when we need it most there is still a lot we can do within the NHS and working with partners to support this agenda. We can think of prevention at two levels. The NHS has a major role in promoting healthy lifestyles amongst the people who use its services and will do so all the more effectively if it brings that approach to how it treats its own workforce. It also, though, has a key role around early intervention and secondary prevention, in particular for those at risk of a crisis in their physical or mental condition.
My last resolution relates to the involvement of patients and carers in decisions about their care. This something which we have been starting to do better in the NHS and I can certainly see some of the progress we have made in my organisation in recent years on this agenda. However we can go further and we need to start judging things not just by the good conversations we have had but what we have done differently, both individually and collectively, as a result of listening to patients and carers.
The next year will not be easy for anybody in the NHS but it will be better if we start with the right intentions.