Securing a healthy future

With 2014 set to be another challenging year for the health and social care system, we speak to Chris Ham, Chief Executive of The King's Fund, to get his take on what the year ahead will bring.

In 2013, we saw the publication of the Francis report into failures of care at Mid Staffordshire NHS Foundation Trust, and the Keogh and Berwick reviews of quality and patient safety. These reviews demanded cultural transformation and came hot on the heels of the changes ushered in by the Health and Social Care Act 2012. Coupled with increased financial and performance challenges, this placed those in the service under real pressure in 2013. What’s the outlook for 2014?

'I think 2014 will be even more challenging than 2013,' says Chris. 'The pressure will grow, particularly on NHS organisations trying to balance budgets, and on the social care sector too. It's going to be increasingly difficult to maintain good performance on measures such as waits in accident and emergency departments and referral-to-treatment waiting times simply because demand is increasing and resources are flat at best and, in some cases, declining.'

Political tension

The run-up to the 2015 general election will add to this already pressurised environment. The NHS is certain to be one of the main issues of debate during the election campaign and scrutiny of it will only increase. 'The government will want to navigate its way to the next general election without the NHS being back in the headlines for the wrong reasons,' explains Chris. 'There's also a real risk that the NHS will become a political football in the debate leading up to the general election, being used by all parties to gain a political advantage. The danger is that this demoralises both staff working in the service and patients.'

Valuing leadership

Set against this background, effective leadership is more vital than ever to steer NHS organisations through these choppy waters. With many senior leadership roles unfilled on a substantive basis, more must be done to strengthen and support leaders.

'We'll be making the case for valuing, rewarding and strengthening leadership and management, at a time when there is likely to be a focus on management costs. You can't run a big complex organisation like the NHS on the cheap and managers have a critical role in working with doctors and nurses and other clinical staff in using budgets efficiently and delivering better patient care. If we don't, there is a risk that the NHS can't recruit and retain the experienced, skilled and talented people on whom its performance depends.'

Mapping the future

In these challenging times, The King's Fund will continue to be an independent and trusted source of unbiased information about what's going on in the NHS, with publications like our quarterly monitoring reports. While this analysis is important, it needs to be supplemented with concrete proposals for the future.

'During 2014, we'll be clear about what we want to see both from this government and the post-election government. Any future government should be very cautious indeed about further reorganisation of the NHS, and must ensure more is done to engage staff, particularly clinical staff, to take more responsibility for managing budgets and services, helping the NHS to deliver incredibly stretching financial and performance targets.'

The independent Barker Commission will play a pivotal role in shaping the debate about the future. Set up in 2013, the Commission is looking at whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose. 'These are very big and very difficult questions,' explains Chris. 'The main political parties have appeared reluctant to take the lead in addressing these fundamental questions but they need to be answered.'

The Commission will be taking an evidence-based approach to examine whether having separate entitlements, and funding and delivery systems for health and social care makes sense given the challenges these services are now facing. Based on the evidence it gathers, the Commission will describe the main options that are open to us. The stakes are high, as Chris explains: 'The Commission will succeed if it produces evidence to inform debate ahead of the 2015 election and influences the decisions of the next government on what needs to be done to secure health and social care for the future.'