It’s all change once again at the top, but the NHS challenges remain the same

I have long been an avid reader. I consume the written word with as much gusto as I imbibe wine. One of the most famous books of all time is one I haven’t yet read. It’s John Milton’s ‘Paradise Lost’. Actually, Milton’s epic poem is not one book, but 10 books, which together contain 10,000 lines of verse. Every word and line had to be dictated by Milton, as by the time he wrote it he had gone blind. I’m sure one day, I’ll get round to reading it. Milton was also famous for giving us the proverb, ‘every cloud has a silver lining’. It comes from his earlier work, ‘Comus’, which I’ll admit I also haven’t read yet. It is a familiar saying, and one that came to mind last week, with the news that Dr Feelgood* was removed from her role as Secretary of State (SoS) for Health and Social Care. She was replaced by Steve Barclay.

Regular readers of this blog will perhaps recall that I was rather vexed about Steve Barclay’s appointment in a blog I wrote at the end of July this year. Partly this was based on his rather strange views on health and the NHS. For example, he believes that nurses don’t need to have a degree to be a nurse, and we should be able to get the training done in 2 years not 3. You can read my argument as to why I thought this was, and is, absolute bunkum here.

Steve Barclay was previously appointed to the role of SoS on 5^th July this year. The Health Service Journal greeted the news with the headline ‘Steve Barclay is the NHS leadership’s worst nightmare’ and suggested he saw the NHS as a ‘bottomless pit, resistant to change and unaccountable’. A bit harsh perhaps. He certainly has a reputation for thinking that the NHS has too many managers. The reality is that the NHS management costs are considerably lower than most of its western counterparts.

Unbeknown to Barclay, having only been in post for just 58 days, he was to lose the role some 6 days later when Liz Truss took office. Just 79 days later, he is back as SoS once again. Things have changed for the worse during those 79 days. Ambulance services are stretched to almost breaking point as patient flow through hospitals is severely impacted by the continuing shortage of social care provision. Covid cases are once again adding to the problems of managing the ever-increasing demand for health care as well as dealing with the 7 million people waiting to be treated. The cost-of-living crisis has been made even more difficult for an estimated 8 million people who are now struggling to pay bills.

Some of these folk will be working in the NHS, and we are seeing unprecedented numbers of colleagues leaving the NHS for better paid jobs, and jobs that don’t have such a intrusive impact on family life. It matters. Have a look at this article from Torsten Bell in last week’s Observer. He acknowledged that money is an important factor (pay in the private sector rising at 6.2% compared to the public sector average of 2.2%). However, drawing on a recently published research study, other factors such as staff engagement are more powerful in terms of staff retention. Interestingly, the study also posits that when nursing staff leave, senior medical staff follow – but not the other way around!

During his previous time as SoS, Barclay had suggested that the answers to the problems facing the NHS was to hold a ‘hackathon’, which was another reason why I was less than enthusiastic about his appointment. But we are in strange times. Whilst having absolutely nothing to do with Steve Barclay, last week, NHS England’s David Sloman, (Chief Operating Officer) sent out an invitation for people to attend a Winter Improvement Collaborative event in London next Tuesday. When I say an invitation, it’s perhaps more of an imperative, as each acute trust, ambulance trust and integrated care board must send at least one executive director to the event. He did, however, say please.

The event is the first in a series to be held over a 10-week period. It is not quite a hackathon, but has similar shades of approach. Described as adopting a ‘lock-in’ style methodology, each event will see senior clinical and operational managers working through real life problems and issues facing the NHS. Real time data will be used to provide the basis for root cause analysis, leading to the co-design of improvement plans, with a single set of metrics, and which can then be adopted and trialled at a local level. I don’t like some of the language, but I do like the idea of a collective approach to generating new ideas for seemingly intractable problems. I like the idea that contemporaneous data is to be used to analyse and prioritise decisions that will result in the greatest impact being achieved. I like the idea that nothing is ‘off the table’ in gaining a better understanding of the barriers to more local decision making and action. And I really like the espoused determination to undertake this work at pace.

The outcomes from this work cannot come quickly enough. This year’s winter looks set to be the toughest one yet. John Milton went on to write a sequel to his earlier work, which he called ‘Paradise Regained’ (and yes, I haven’t read that either). There aren’t any easy or quick answers to the challenges facing the NHS, and perhaps there never was an NHS paradise. However, it’s only fair to give the new SoS an opportunity to demonstrate the leadership necessary to keep our NHS safe and secure, just as every day, colleagues continue to find ways to deliver high quality, and safe services for patients.

 

* Whereas I previously feared for the NHS under Therese Coffey’s management, now it’s my hens I worry about.