We must make the case with the new administration | Niall Dickson

Niall Dickson

With the new leadership in place, we must continue to assert the need for NHS funding and reform, says Niall Dickson, chief executive of the NHS Confederation.

No one wants to be accused of being a moaning minnie. 

The queue to spend public money is long. The case for investment, after years of austerity, is in many areas of public service unanswerable. Yet we must make the case for health and for social care and we must spend wisely what we have already been allocated.

But convincing this administration, like the last, will not be easy. Unlike so many of his colleagues, the Secretary of State is back, having manoeuvred himself from Osborne protege to leadership contender to Boris cheerleader in three short and smart moves. Like the Prime Minister, he is committed to solving the short and long-term social care crisis in England. But abutting the other side of Downing Street sits the Treasury and a new Chancellor who not only favours fiscal prudence, but also has his own priorities at a time of record business uncertainty. We will continue to make the case for immediate funding to avert disaster as well as long term reform.

At the same time, we must make the case for pension reform and capital investment. These are both issues that are solvable and there is a strong economic as well as a strong patient care argument for doing so with speed and greater conviction. On pensions we will now call on the Chancellor to scrap the tapered Annual Allowance changes introduced in April 2016 – we accept that in return the Treasury may demand the introduction of other pension linked tax changes to compensate for any potential loss of tax revenue.

However, the current arrangements have produced highly unfortunate and unintended consequences and must be remedied as soon as possible. We will also continue to seek ways to influence reform of the NHS Pension scheme through the introduction of more flexibilities to cope with the full range of individual employee circumstances. We are however clear that the way the tapering of the annual allowance operates is at the heart of this self-created mess which is affecting not only senior doctors and other senior professionals and staff, but also the patients they serve.

On capital, there is a lot of support for the fact that the Secretary of State has made tech his mission – but he must recognise that without a significant capital injection his mission will fail. Capital per worker in trusts reduced by 17 per cent between 2010/11 and 2017/18. The result is a rising backlog of maintenance and a lack of investment to support innovation. In our own survey of healthcare leaders, eight in ten respondents say a lack of NHS capital investment has inhibited the ability of local health systems to deliver the goals of the plan. 

The Topol review was full of warm words but its ambition of total interoperability will only be achieved with serious digital investment. 

And your experience may be different, but amber and in some cases red lights are flashing all over the country. A and E departments, the canary down the NHS mine, are facing record demand, with performance against the four-hour A&E target in 2018/19 hitting its lowest level since records began 15 years ago

NHS England is asking trusts why demand is going through the roof. It may be that already the extremely challenging predictions from the IFS and The Health Foundation which we helped to produce last year are optimistic.

The answers to the relentless rise in demand lie within the NHS plan, but much of what needs to be done remains at an embryonic stage. We know that when the system is stretched the tendency is to retreat into organisational and sectoral silos - we also know that is a zero-sum game. 

In recent weeks, I have heard cries of woe from just about every sector and worryingly quite a bit of criticism of the failure of other bits of the system. We do need to rise above this - we may all have our prejudices – ‘working with GPs is like herding cats’,  ‘the most able managers and doctors are in the acute sector’, ‘community services are inefficient’, ‘the acute sector squanders vast sums and starves community services’, ‘mental health providers are much more efficient/much less efficient (take your pick) than other parts of the system’, ‘commissioners add no value’ and ‘local government is more concerned with potholes than the health of the population’. Some or none of these swipes may contain fragments of truth but none of it and the attitudes which underpin them will help us tackle the underlying challenges facing our health and care system. 

Breaking free of the silos we all inhabit is going to be a real challenge. But unless we see value in others and value in setting up new ways of funding care, new ways of working, new pathways with integrated teams supported by interoperable information systems, we cannot hope to succeed in managing rising demand. There are many unanswered questions going forward, but if we can agree hard outcomes for improving population health, we ought to be able to come together in local systems to deliver them.

Niall Dickson is chief executive of the NHS Confederation. Follow him on Twitter @NHSC_Niall

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