The audience listened to three takes on the current political environment from journalist and commentator, Steve Richards, the Chair of the Health Select Committee, Dr Sarah Wollaston MP, and Jill Rutter from the Institute for Government. There was consensus among the speakers who believed that the NHS and social care would not be a major political focus during this parliament because of the time and energy required on Brexit. This creates risk as well as opportunity, but the government is unlikely to change its focus despite the chorus of concern from within the NHS community. The spectre of a bad winter, something many in the NHS are expecting, could force the NHS to the top of the agenda, but by that time it may be too late to avert a crisis.
But what does this lack of government focus mean for NHS and social care? Does it matter and will it change how NHS and social care leaders operate? Is it an opportunity or a threat?
The contention expressed at the event was that while politically led change for the NHS is unlikely in the short term, the need for the service to transform is imperative. The speakers suggested there is an opportunity for bold leaders to instigate change when there is no time or appetite for fundamental reform centrally. On one hand, this could encourage innovative leaders from across the service to pursue significant change without central oversight especially in the early part of the parliament when some changes could be made within the current legal framework. On the other, as many leaders can attest, if proposals are radical and not universally popular, as will be the case, the necessary support for them centrally and from local and national politicians could be thin, caveated or non-existent. Furthermore, if there are changes that require reform to national governance or indeed legislation, this returns to the problem of no time or energy as a result of Brexit issues.
Experience suggests that the ability of leaders to develop such ideas and garner the crucial support they need to begin implementation, is much greater for those systems where performance on national standards is strong. This point is apparent in NHS England’s inaugural sustainability and transformation partnership (STP) progress dashboard where operational performance measures predominated when 44 STPs were classified. In the dashboard, higher performance appears to equate to greater confidence in and support for an STP’s strategic agenda. The risk is some systems with poorer performance may have as great, if not greater, need to reform but may not get the full support necessary to enable early and substantial progress.
The reality for many local leaders is that the focus on the key issues of quality, access and finance through the lens of the impending winter means there is little time to pursue such ideas even if the conditions were more amenable.
In addition, the expectations of what extra funding will deliver will be high, encouraging further short-term responses. Addressing the immediate and pressing challenges is a key role for NHS and social care leaders but ultimately will not help to deliver the transformational change the service requires for the long term. Returning to the opportunity highlighted at the event, this period of minority government could be a golden chance to promote such change through the STPs and accountable care systems work now being pursued across the country. The speakers reflected a view made by many that STPs have suffered by appearing to be secret plans focusing on cuts to services rather than as transformational partnerships securing a sustainable future for health and care. They suggested that engaging with patients and the public should be a priority for local leaders.
The challenge is to take the opportunity the current climate presents to expedite the work on new models of care and the design of local health systems. The question is whether leaders can create the space they need to seize the day.