Steering a path through choppy waters

We talk to Chris Ham, Chief Executive of The King’s Fund, about the challenges and opportunities facing the NHS in 2013. How does The King’s Fund hope to not just facilitate understanding of these, but also help steer a path that will lead to an improved health care system?

It’s clear that 2013 will be a challenging year for the NHS, as Chris explains: ‘There will be the ongoing pressure to find long-term efficiency savings while maintaining the quality of care that’s provided.’ To date, the NHS has held up well in the face of these demands, but Chris argues that could change in 2013: ‘With a growing number of providers now in deficit, increasing waits in accident and emergency departments, and cuts in social care funding and support, strain on the system is greater than ever. The Fund’s most recent Quarterly monitoring report found that there is concern that quality of care may suffer as the productivity challenge really begins to bite in 2013.’

Knowing the risks

These financial and service pressures are testing enough without the additional impacts resulting from the implementation of the Health and Social Care Act 2012. Chris argues, ‘There is a real risk of distraction and loss of focus at precisely the time when the service needs it most.’

Implementation of the reforms also presents a danger of duplication and confusion between the organisations that have an oversight role. ‘The leaders of the Department of Health, the NHS Commissioning Board, Monitor, the Care Quality Commission, Public Health England, Health Education England, and the NHS Trust Development Authority will need to display an uncommon ability to work together effectively to make sure this doesn’t happen,’ says Chris.

The spotlight will be on some of these regulators with the publication of the Francis report shortly, which is sure to be a pivotal point of 2013. The Inquiry’s remit was to look at the role of the commissioning, supervisory and regulatory bodies in monitoring of Mid Staffordshire NHS Foundation Trust but Chris advises caution against seeing regulation as the main solution to the problems that arose. ‘While it’s important that we make regulation as effective as possible – meaning better, rather than more, regulation – our main focus should be on the role of leadership and culture in creating environments in which clinical teams can provide the best possible care within available resources. Staff and patients must be able to raise and share concerns within their organisation knowing that feedback will be responded to.’

Making change happen

Translating talk to action is a pertinent theme for 2013; this must happen after the Francis report and also if we are to make integrated care a reality. ‘Integrated care is particularly important in meeting the needs of older people, who are major users of health and social care services,’ explains Chris. ‘Building on last year’s roundtable discussion, and the personal commitment of the Care and Support Minister, we made great progress in 2012 and we need to maintain that momentum. The challenge in 2013 is to move beyond warm words to meaningful change on the ground.’

Chris outlines the Fund’s commitments to making this happen: ‘Our priorities include supporting leaders in a small number of areas to develop integrated care at scale and pace and offering a new leadership development programme focused on what it means to share leadership across a whole system of care. We will also continue to propose changes in policy that are needed to remove barriers, such as current payment mechanisms.’

Beyond 2013

Getting a grasp of effective integrated care models feeds into the Fund’s work to stimulate and influence debate about the future of health and social care. Launched following publication of the Transforming the delivery of health and social care report in autumn 2012, the Time to Think Differently programme aims to engage people across the system and promote discussion about innovative ways of delivering high-quality care. Chris argues that the time is right to do this: ‘Our health care system is facing a number of unprecedented challenges: an ageing population; the changing burden of disease; and rising patient expectations. We want to see a better informed debate about future models of care and how we pay for that; we’ll be publishing a report next week by John Appleby, setting out long-range funding forecasts, which will add to that discussion.’

With many difficult issues on the agenda, what role does the Fund play in making sense of these and finding ways to move forward? ‘The Fund is in an important and privileged position to be able to speak truth to power,’ explains Chris. ‘We can hold up a mirror to those in government, backed up by rigorous research and analysis, that highlights success and draws attention to weaknesses. In 2013, I want to consolidate and strengthen that position; at this time of flux and challenge, our independence and insight are needed now more than ever.’