Chris Ham, Chief Executive
We see two versions of the NHS in our work. The first is an NHS under growing financial and operational pressure, working hard to meet the needs of patients with constrained resources. The second is an NHS continuing to innovate by developing new care models better suited to changing needs in the population.
Alongside our established role as a trusted source of information about the state of health and care in England, we’ve made recommendations in 2016 on what government, national bodies and NHS organisations need to do to rise to the challenges they face. These recommendations were brought together in our agenda for action back in April.
We will be using our resources in 2017 both to report on what’s happening in the NHS and social care and to support leaders and staff in improving the health of their populations. Now more than ever, independent foundations have a vital role in speaking truth to power, and playing an active role in finding solutions to the unprecedented challenges faced by national and local leaders.
Richard Murray, NHS finances
During 2016 there have been a number of key announcements – the NHS financial reset, the oversight framework for providers – that really change how the system works. It’s interesting how quickly, in response to financial pressures and performance pressures, the centre has decided to rip up the rule book and start again.
Until this year, deficits in the NHS looked like they were just spiralling upwards. Even when you take into account the extra money that’s been put in, the NHS seems to have halted the rise and, at a time when more people are arriving in hospital and when costs and meeting demand are increasing, that’s an enormous achievement.
We shouldn’t forget that even as services struggle, some of them are innovating and developing new services that help them deal with patient demand in a more flexible, future-proofed way. I think some of the developments that are going on in vanguards, in creating better integrated care, are great. They may not be the stuff that hits the headlines, they make not be the stuff that saves the budget this year, but they’re the right thing to do and it’s important that the NHS is still managing to do them despite all the pressures.
My hope for 2017 is that the NHS and social care manages to make the most of the opportunities created by sustainability and transformation plans (STPs) to really move beyond what some of them have been trapped on – which is worrying about deficits – to take more strategic, joined-up action that has been promised for years, but which the system has struggled to achieve.
Richard Humphries, social care
2016 saw social care shooting up the agenda, both in the Fund – with the appointment of Patrick Hall as Fellow in social care policy – and externally. That NHS leaders are queueing up to say that if there is any extra money it should go to social care, not the NHS, is remarkable. Our Home truths report with the Nuffield Trust was instrumental in shaping a new commitment to addressing problems in social care. I can’t remember a time when there has been such a unified chorus of concern around social care and the Fund has played a part in this almost game-changing shift in perception.
Throughout the year I have continued to be impressed and inspired by how staff throughout the NHS, local authorities and independent care organisations are working together to improve outcomes for local people. My hope for next year is that local systems can really use the STP process to forge better relationships to deliver more joined-up care.
We are facing the huge challenge of more people with complex health and social care needs. There’s no top-down solution for this. The best solutions are bottom-up, driven by the enthusiasm and commitment of local leaders: my hope is that these efforts are re-doubled despite the tough financial circumstances.
Beccy Baird, general practice and community-based health care
In 2016 stories about the challenges facing general practices across the country really began to hit the headlines. Our report on the pressures facing general practice, using both qualitative research and some new data on activity, provided a clear, independent voice about what has been happening in general practice. We’ll be building on that in our work in 2017.
We’re going to continue to publish regular analysis of activity in general practice and will be looking at what changes have been made in general practice one year on from the GP Forward View. We’ll also be publishing new work on community-based health services. We’ll be thinking about what a future vision for really good community services-based care looks like and how general practice and community health services might need to change to respond to that vision, so that services can be more sustainable for the future.
My wish for 2017 would be that STPs truly focus on transforming the delivery of community and primary health care so that people can receive the care they need to keep them healthy and at home.
David Buck, public health and inequalities
One piece of work I think will be important next year is our project on the future of HIV services. This will look across the whole pathway of care and will allow us to use our voice for the future of care for people with HIV. It will also give us an opportunity to reflect on how health reforms are working in practice, particularly with regards to the fragmentation of commissioning and responsibilities for different parts of the pathway of care. I hope it will re-energise the debate around HIV: HIV is becoming a chronic condition because of improved survival rates, and the system hasn’t caught up to what this implies.
One development I would like to see in 2017 is the appointment of a Cabinet Office minister for public health, which the Health Select Committee argued for in its recent report. Given all the cuts to public health budgets, the uncertainty of what business rates may bring, and given that we know wider government policy has a huge effect on public health, there is a strong case for having a cabinet minister to think all these things through and to hold the ring on the wider effects of government policy on public health. There’s a lot of support for that. I’m not sure that it’s likely to happen, but that’s what I would like to see.
Helen Gilburt, mental health care services
One important development in 2016 was the report from the independent Mental Health Taskforce. It feels like for the first time in a while we’ve got a clear strategy, backed up by an implementation plan, as well as some funding and leadership. The prominence of mental health has been growing and now we’ve got a national strategy which we can start to hang some of this off, which is exciting.
At the Fund, we’re building a presence and influence in the mental health sector. Because we’re independent we can take a step back; we work across the whole system and we’re challenged by and benefit from the knowledge and expertise of colleagues at the Fund who know other areas of care. This has helped us think about mental health within the whole system, which gives us a unique perspective.
Going forwards we’re thinking about how to develop and support changes that can bring about improvement, such as looking at how mental and physical health can be embedded in new models of care and how the quality of mental services can be improved, as well as looking at what’s happening on the ground and holding the system to account.
Nicola Walsh, sustainability and transformation plans (STPs)
In 2016, the Fund has taken a leading position in driving forward the notion of place-based plans. As part of this work, we’ve started working with several senior leadership groups to support them in their work of making a reality of the proposed changes. This has involved facilitating some difficult conversations, providing leaders with the tools to work more collaboratively with one another and providing examples of what’s happening elsewhere nationally and internationally to deliver more integrated services.
Conversations around STPs have tended to be with senior leaders so far, but going forward into 2017, we’ll have a role in working with others – whether that’s patients and the public, directors of HR, local GPs, local nursing teams and hospital consultants/ medical directors – about what the plans actually mean. Strengthening local community-based services is a key area for many places. We’ll be supporting the implementation of some of the changes that people want to see locally and looking at how the plans can be translated into reality.
In 2017, I would like to see greater political engagement and recognition of the effects that the current financial constraints are producing at a local level, and a greater valuing of the workforce who deliver care.
Marcus Powell, leadership
2016 brought some big strategic developments with major leadership implications. The publication of the national leadership strategy was really significant in terms of its potential impact on the NHS. Its aspiration of collective, compassionate leadership is a huge ambition. For me, the really important thing is the extent to which the NHS has the capacity to really develop leadership that is collective and compassionate, and that also delivers. It’s really important that we get into a space of implementation, not just strategising.
STPs, from a leadership point of view, are a huge development because they require people to work across organisations – if they fulfil their potential they’re a genuine opportunity to transform the system, but it’s going to require a lot of leadership capacity to be able to do that.
The transformational agenda will require a lot of support from national bodies, and a lot of leadership support. My hope is that people recognise the amount of resource that’s going to be required for that – in terms of time, money and capability.
Alex Baylis, Brexit, workforce and STPs
Following the Brexit vote in June, there has been a fantastic show of support from many NHS staff for their colleagues from overseas. Our reliance on staff from overseas is a sad indictment of our capabilities for workforce planning, and it’s important that we continue to attract and support staff from overseas. Brexit is also contributing to a sense of political instability, which is damaging in itself, but also means that serious concerns about health and social care sometimes get pushed out of the limelight.
For all their shortcomings and difficulties with process STPs have been an important development. They’re important for two reasons: one, because the system based on competition has run out of potential leading to fragmented care, an inefficient system and unhelpful cultures. Two, because health services fundamentally work better as systems – it’s easier to design for a local population’s needs if you design across a system.
In 2017 I’d like to see us get more consensus on the thinking about and action on improving primary care. The current system is not working well for GPs or for patients. If the system for primary care could be made to work better, so many other changes in community-based care and hospital would become more possible.
Today NHS has 20% of staff from BME background and 45% of doctors (I repeat 45%) are from BME background! Roger Kline has published lots of evidence about 'Snowy White Peaks'. It is sad irony that NHS England, NHS Improvement, NHS Confederation, NHS Employers, CQC, GMC, NMC, NHS Providers do not have any senior BME leaders in Directorship position where policy decisions are made!
I sincerely hope 2017 will be the year where everyone realises the importance of true inclusion and diversity and all leaders are appointed only on merit. Subconscious bias, club culture, old boys' network and so on is still so common and in our NHS, patients, staff and NHS suffers. Unless we get WRES right I doubt if we will ever be able to sort out NHS or social care or our wonderful nation. Some good leaders in many of these Institutions gives me hopes.