Stepping up to the task

Richard Murray, Director of Policy, joined The King’s Fund in January. Three months into the new job, he shares his views on how the health and social care system is coping in the face of ongoing pressure, looks ahead to the future and explains what he hopes to bring to his new role. 

What will your previous experience bring to the role?

Before joining the Fund, I was Chief Analyst at NHS England and, before that, held various roles at the Department of Health, including Senior Economic Adviser; Director of Strategy; Director of Financial Planning and Chief Analyst; and finally Director of Finance, Quality, Strategy and Analysis. These roles gave me broad, system-wide understanding of the health service. I didn't think just about acute trusts, or primary care, or one disease – the key to these roles was to bring all the knowledge and analysis back together into one place, to look for the best mix of coherent policies and measures to get the best outcome.

In the work I do I try to find a balance between what policy can achieve, on paper, and what people at local level find useful and helpful. It's about trying to find the happy medium between what a policy wonk, thinking up some great scheme, might develop and what people working directly in the NHS might be able to do something with.

At a time of ongoing pressure across the health and social care system, what’s your take on how well the system is coping?

I think the NHS has held up remarkably well. If, in 2009, we could have looked ahead to 2014 and seen where we are, I imagine we'd have been pretty pleased. However, the tension is now growing, with signs of increasing difficulties in services and ongoing financial pressure. Some indicators are going in the wrong direction faster than people would have expected. There seems to have been a shift in the mood about how well the NHS can hold on to the money over this year and next. It's likely that if no additional money is found above the current government settlement, the NHS will face major financial problems by 2015.

The challenges for social care are even greater – it is facing worse funding problems, having already dealt with cuts and is at the sharp end in terms of the demographic challenges of an ageing population with increased multiple and long-term conditions.

What are the challenges for the NHS?

I think we know what we need to do, in terms of providing better services to people in community settings, more integrated care and a wider array of services in primary care to help people stay well for longer. The challenge is that transformational change will take time to do and the problem is we’re out of time. The King's Fund recently published a paper on how service transformation was achieved in mental health and so many of the things that enabled that change to happen aren't around now: there's no additional money; no 'double-running' costs that allow new services and ways of working to be established before old ones go; too little recognition that change can be expensive; and no recognition of how long it might take.

Also, although we might know what we need to do in the future, the question of how we do that is still the subject of much debate. Add to that the fact that we have a system with multiple leaders – NHS England, the Department of Health, Monitor, Care Quality Commission, NHS Trust Development Authority – and it’s clear that how we achieve transformation has got a lot harder to think through.

Where will the Fund be focusing its efforts to support the system?

We'll be focusing on two areas: the first is helping the service keep its eye on some of these longer-term gains, both what they are and how we get there. The work of the Barker Commission will play an important role here, with the interim report due to published next week. In the short term, it's trying to make sense of what's happening, as performance changes and/or the financial pressures intensify further, to help people understand what's happening and where the system is going. Our quarterly monitoring reports and upcoming paper on productivity in the NHS will be key to this. 

Why did you want to join the Fund?

I think the health and social care system is facing a unique and desperately serious set of challenges, and the ability to bring all this together in one place is very difficult now. The Fund is almost unique in the breadth of its interests across the system and it's got people who understand policy, who understand evidence, and who are engaged in the policy debate. And it's also incredibly well connected with leaders out in the service, and can talk to them about what they are doing, what they would find helpful and the challenges that they face. That's a pretty unique set of skills, combined with a strong reputation – all of which the Fund will need if it is to step up to the task over the next months and years.