The first is ever-increasing financial and service pressure and the effect this is having on performance. At an aggregate level, the NHS will just about balance the books in 2013/14, but with a growing number of providers in deficit. While the deficit among providers will be compensated for on the commissioning side, a number of CCGs will also end the financial year in the red. His first priority must therefore be to work with Monitor and the NHS Trust Development Authority to plan how to deal with widespread financial distress in the absence of the traditional brokerage arrangements used by strategic health authorities and of any financial reserves on which to draw. With the question now when, rather than if, the NHS hits the financial buffers, we will examine these issues in more detail in a new report next month.
Second, he must build on the work of David Nicholson and his colleagues at NHS England to make the case for the new models of care described in their call to action. In September 2012, we set out the case for fundamental change when we launched our Time to Think Differently programme. Eighteen months on, there appears to be consensus about the need for change but little clarity about how it will be taken forward. At a time when operational pressures risk crowding out other concerns, articulating a clear and compelling vision of the future has never been more important. The NHS is sorely lacking in optimism and hope and Simon has a chance to put this right. This means describing not only why transformational change is necessary but also what benefits it will bring for both staff and patients.
Third, agreeing with ministers and national partners on how to achieve transformational change is an urgent requirement. One of the ironies of the reforms is that intentions to ‘liberate the NHS’ and ensure that it operates free from political interference have given way to a period when political involvement in the NHS and performance management are tighter than ever before, with inspection the instrument of choice of ministers. Fresh thinking on how to make a reality of new models of care is desperately needed. This means taking a realistic view of what CCGs are likely to achieve in the immediate future and ensuring that the NHS’s most experienced managers and clinical leaders are supported to lead change at a local level.
Often this will require action across a whole health economy with local authorities and third sector partners also involved. The challenge in the reformed NHS is how to secure agreement on the service changes that are needed in the absence of a designated system leader and when so many organisations and interests are involved. This challenge is made even greater by the powers that market regulators have and by their ability to delay necessary changes where these reduce competition. Monitor’s new role in advising on proposed mergers and service changes in the wake of Bournemouth and Poole may help to expedite change.
Having worked closely with Simon more than a decade ago, I know he will have been thinking hard about these issues and will be impatient to make his mark. I expect one of his priorities will be to create a guiding coalition (to borrow John Kotter’s famous phrase) to lead change and improvement in the NHS, learning from the work we did together in developing and implementing the NHS Plan in 2000. Now more than ever the NHS needs collective leadership in which a shared vision and strategy that is compelling and well understood provides the direction for leaders and their teams at all levels in working towards a better future. A year on from the implementation of the Health and Social Care Act, he will find little in the legislation to help him with this.
- Catch up with our resources on the Health and Social Care Act, one year on
- Watch our animation: An alternative guide to the new NHS in England
- Hear Simon Steven's speak at our annual NHS leadership and management summit
- See our Time to Think Differently work
- Read our report: Transforming the delivery of health and social care
- Find out more about our leadership development work