David Sloman, Chief Executive, Royal Free London NHS Foundation Trust, considers the challenges and opportunities for providers which have arisen from the NHS shared planning guidance.
This presentation was recorded at our breakfast event on 22 March 2016.
For me there are three broad points I would make, firstly the subject today is are we in it together? So I think the first question we need to ask is, are we in it? And I think a show of hands, are we in it? Yeah, I think we’re deep in it, aren’t we? So I think we are deep in it and I would also therefore hypothesise if we are in it the only way we’re going to dig our way out of it is by working together. So I think that’s a very, very important first principle around this.
I don’t think there's a single material issue that we face that can be resolved at the level of the individual institution be it a hospital, be it at trust, be it a local authority so I really do think we are absolutely in it together and I think the STP process, it doesn’t matter what it’s called, it’s a process by which we can collectivise efforts and energies in the interest of the populations that we serve.
So I think we are collectively coming together around a challenge and the second point I’d make building on Anne’s point, I think we are collectively coming together around a population. I think place is a really important concept in what we’re about to do. I think if we look at the achievements we’ve made across London in recent years, often it’s been people coming together around particular populations be it the population at risk of stroke, or be it a population of complex elderly folk and people have come together around that place and that population.
So I think for me we’re in it together because of the challenges that we face and the unifying feature we have is the place in the population so I think those are the two things I’d highlight there.
Secondly, I think we do have some reasons to be cheerful, actually, we have some causes for optimism because I think we have a little bit of form. We have done things through, say, cancer and cardiac, around UCLP, we can point to organisations coming together be it around … so, frankly, they’re not very sexy things like consolidating your back office through stuff in the middle of our developing joint ventures, through stuff, I think, right at the tip of a pathway and, again, I think I would point to stroke, cancer, cardiac these are the kind of things we’ve been doing.
I think we’ve also got a few new enablers in place, I think the vanguards give us real opportunity to, I think, break the mould. The Royal Free, we’re part of the acute care pull out collaboration of vanguard. In my neck of the woods we’ve got UCLH relieving of cancer vanguard, we’ve got the ONOH and Moorfields who are leading specialist vanguards, and actually they have one unifying feature and that’s about standardising practice at scale with a view to driving out value in terms of better outcomes and better value for tax payers’ money. So I think there are some new pieces of the jigsaw to play with.
So I think my second point is we have some causes for optimism. I think we have some form. Building on Anne’s point I do also see CCGs starting to collectivise and be clear about … can we use European analogies anymore? Can I talk about subsidiarity and these sorts of things? I think people are thinking about what is best and at what level and I also see the GP practices starting to actively collectivise as providers through federations so I think the zeitgeist is heading in the direction of more collaborative working, people coming together around populations.
I think the other side of that coin is we are not without our challenges as we move into this. In general I think I would highlight three, I think Anne’s point about the tone of the leadership is absolutely fundamental. Frankly, I don’t think it matters what the guidance says, working together is all about trust, it’s all about good relationships and it’s all about good behaviours. And I'm sure if we look across the UK those issues of trust, relationships and behaviours will be on the normal distributive bell curve. So I think there's a real issue there.
The second thing, there are some artefacts that we need to find a way through. So as we move, how I would define it, away from a system which is around promoting markets and competition to a system which is more about planning and which is more about system we need to think through how issues like choice and competition are handled, how regulation is handled and should we be inspecting systems as opposed to institutions if we really are looking at systems in place. And there's some other more technical issues around roles of council of governors and how CCTs do delegate mandates to commissioner scale. But it’s happening, there are places around the country we can point to where people are getting into this one.
And the third constraint I point to is time. So I had the great privilege last Thursday of being anointed as the person in charge of the STP for North Central London. So I was looking yesterday at what I’m expected to do by the 15th of April and after I made the blind see and the lame walk I think we’ll move onto the next challenge that lies beneath it. So there is an awful lot to do in a relatively short period of time.
I do think the key, as Anne says, as ever will come down to leadership, I do think there is a different leadership challenge which is associated with leading systems as opposed to leading institutions. It is about persuasion, it is about how you collectivise people around a vision and the challenge is how we get everybody to lift their heads above the level of the institution and look forward to what we can collectively do for our populations while operating a scale.
So from my perspective, again, I think we are in it together, I think working together is the only way that we’ll meet these challenges. I think the focus on population and place is absolutely spot on. I think we do have some reasons to be cheerful but I also think we do have some strengths that we’ll have to work hard to work through over the forthcoming months.