Three versions of the NHS

In the past week I’ve observed two very different versions of the NHS. I’ve also glimpsed a potential third version, and very much hope that it’s within reach.

Version one is an NHS under severe and growing pressure. Confirmation came in last week’s performance figures which showed the NHS continuing to miss key targets for patient care, in some cases by a wide margin. It was also illustrated by the Care Quality Commission’s reports of hospitals failing to provide adequate care, and by a survey of health leaders by the Nuffield Trust highlighting concerns about workforce shortages and staff morale.

Version two is an NHS developing new models of care better suited to the changing needs of the population. Our conference last Tuesday showcased examples from around England, reinforced by presentations at our follow-up meeting with primary and acute care systems (PACS), multi-specialty community providers (MCPs) and care home vanguards. The energy and innovation on these two occasions were palpable, as clinical and managerial leaders described how they are beginning to make a reality of the NHS five year forward view.

The challenge for leaders is to see version two as a major part of the solution to version one. The pressures facing the NHS will not be solved by staff working harder or through ‘sticking plaster’ repairs to outmoded models of care. Something different is needed, and the promise in the most advanced of the new care models is of transformational change that will bring benefits to patients and populations while at the same time improving the working lives of hard-pressed staff.

This is already happening in the MCPs, where the Modality super-partnership in Birmingham shows the benefits of practices working at scale and embracing new technologies that can transform the experience of patients. It is happening in the PACS, where areas as diverse as Northumbria, Morecambe Bay, Salford and Somerset are developing accountable care organisations and systems to join up services. And it is happening in the care home vanguards, through use of technology and workforce changes to overcome the fragmentation that often results in poor patient outcomes.

While it is important not to exaggerate what the new care models have achieved, there are real grounds for optimism that the work they are doing will contribute to resolving the problems facing the NHS. All the more important, therefore, that they receive the funding and support needed to extend progress made to date, and to share and spread learning to other areas. They also need time to demonstrate results in a context where there is growing impatience in government at declining levels of performance and frustration at the apparent inability of the NHS and its leaders to turn this around.

The risk this creates is that version one will trump version two as old-style performance management takes precedence over change being led from within the NHS. There are already signs of this happening, as in the funding provided to the vanguards in 2016/17 being released only when providers have agreed control totals with NHS Improvement. Further moves of this kind will dampen the enthusiasm that has been the hallmark of innovative partnerships in the new care models programme on which future progress depends.

The future I’d like to see is one in which national NHS leaders work thoughtfully to calibrate the respective priority to be given to versions one and two. To be sure, they must redouble efforts to stabilise and ultimately improve performance, but this should not be at the expense of a continuing commitment to support work under way in many parts of England to transform care. National leadership must go hand in hand with freedom for local leaders and staff to implement and spread new care models to secure the long-term sustainability of the NHS.

It’s this kind of future that we have argued for in our agenda for action for the NHS. As leaders across the country gather for the annual NHS Confederation conference in Manchester, it’s the future we need to create together. Let’s call it version three.

• Tackling the growing crisis in the NHS: an agenda for action