Back to the Future Ambitions

I have always enjoyed the early mornings. Long before I started writing this weekly blog, or tweeting as part of the #earlyrisersclub, I would get up early and sit with a cuppa and let the quietness of the day envelop me. It was a great way to start the day, and it was a welcome pause before starting the commute and my workday. Weekends were the precious oases of freedom, and I would rise early so as not to waste a single moment of the day. Even in these days of retirement where every day is like a Sunday, I still get up early and try not to squander the time. And last week I was reminded of a Sunday nearly 23 years ago.

I had been reading the newspapers online and saw a reference to Princess Diana’s death. For some reason, I read that she died on the 31st July 1997. Actually, it was the 31st August 1997. I should know, as on that Sunday 23 years ago, I got up to do a 15 mile sponsored walk. Turning on my car radio, the news was of Diana’s death in Paris. It was early in the morning and so the detail was not really known as to what had happened other than she was involved in a car accident, and the driver and her then partner, Dodi Fayed, had also been killed.

I didn’t hear much more about her death then, as I was to spend the day on the sponsored walk. I cannot remember the charity I was raising funds for, but I think it was one connected to what is now East Lancashire NHS Trust. The walk was on the unopened M65 motorway extension that connected the M65 to the major M6, M61 junction. It had been a controversial road build with many clashes between security staff and ‘eco warriors’ as they tried to halt the building work. On that Sunday there were just the walkers and walk marshals. I can remember it being a bright sunny day, but conversations were sombre and muted as people discussed the news.

Interestingly, the eco warriors won out in the end. The motorway was officially opened in the December of that year, but shortly after it opened, the tarmac had to be relaid with a quieter version, as the road noise was so great it stopped birds of prey (particularly owls) from foraging effectively! The motorway was opened by the erstwhile Home Secretary, Jack Straw. He was a member of Tony Blair’s Labour Cabinet. As it was a year of celebrations recognising 50 years since the NHS came into being, 1997 also witnessed the publication of the New NHS; Modern, Dependable White Paper. The White Paper was ambitious and promised more new money, moving money from bureaucracy to front line care, integrated care, with an emphasis on primary and community care and greater use of new technology to make health care provision more effective.

It may be 23 years old now, but it is still worth a read. You can do so here. Why do I say that? Well last Friday, at 16.30.07 precisely, NHS England and NHS Improvement (NHSE&I) published its long awaited ‘letter’ setting out the Phase Three NHS response to the Covid-19 pandemic. It also makes for an interesting read, see here. Now my J, who is a communications expert, says one should never publish anything late on a Friday afternoon, other than if you don’t intend people to respond or it’s bad news (or both). However, on this occasion, the letter was long-awaited, its publication being promised weeks ago, and I expect many NHS senior managers have been poring over its content since it dropped into their inbox.

Like the New NHS White Paper, the NHSE&I ‘letter’ is ambitious. Its aim focuses on 8 clear areas for action, which together will; accelerate the return to near normal levels of non-Covid-19 health services; prepare for Winter demand pressures, including probable further Covid spikes; lock in the beneficial changes achieved during the first peak, and support the future action on inequalities and prevention. As with the New NHS White Paper, there is also guidance on how finances will be handled going forward to the end of this financial year – Unlike the New NHS, the sums of money involved are phenomenal and completely dwarf that spent 23 years ago on improving the NHS.

There is a recognition. up front and centre, of the importance of supporting all those who work in the NHS, whatever their role. This was something emphasised by Matt Hancock, Secretary of State for Health and Social Care, in his speech to the Royal College of Physicians last week. You can read the transcript here – it’s full of little homilies ranging from the Great Fire of London, town planning in Finland, the Battle of Trafalgar, Ikea car parks and the Road to Wigan Pier. I think his speech writers had a competition going to see who could get the most diverse and interesting historical facts into his speech. But in fairness, his ‘7 cultural lessons’ of how the Covid -19 pandemic has up to this point been responded to and how we might create a future healthcare service that builds upon these lessons was an ambitious look into the future.

However, and despite the recognition there has been of the critical importance of only being able to achieve these ambitions if we have the staff to develop and deliver the future services, I think anyone reading Sir Simon Stevens’ letter will be disheartened. As has been noted elsewhere (see here for example), like many people, lots of NHS staff are exhausted, anxious and worried about the future. The adrenaline-fuelled response to the early pandemic demands has long since dissipated and been replaced by the realisation that we will be living with Covid-19 for a long time.

I wrote and had my first ever paper published in April 1998, just a few months after the New NHS White Paper was published. It took as its focus, the challenges and opportunities there were in the NHS to achieving the White Paper’s ambitions. 23 years on, those challenges (and opportunities) remain – it’s about nurturing staff, embracing change, promoting compassionate leadership and integrated partnerships, supporting innovation and fully utilising all the benefits there are from new technologies. Above all else (as the New NHS White Paper said all those years ago) there should not be a return to the old centralised command and control systems of the 1970s. Sadly, I didn’t see that in the NHSE&I letter.