2015 is last chance saloon for the health service

Shortly after next year’s general election I will start my 30th year working in the NHS.

‘It is no longer enough for the NHS to be satisfied with the passivity of survival’

During this time, the NHS has survived crises of finance, quality and confidence. Often it seems to have come out stronger and has made huge strides in improving healthcare and outcomes. Yet my current experience is that the very essence of a universal healthcare system that delivers high quality healthcare regardless of the ability to pay is now under greater threat than at any time in my career.

That threat comes not from finances, tight though they undoubtedly are. Instead, it comes from the changing needs and expectations of the population we serve today and our failure to have an effective open and honest discussion with them about what needs to change.

It is no longer enough for the NHS to be satisfied with the passivity of survival. It ought to be looking to move from “good” to “great”, and it needs to flourish to become a heath and care system fit for the needs of people living in the 21st century, not the 1970s. Stagnation will cause terminal rot.

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Filling in the gaps

But seeking to preserve is not the right solution. We must not confuse securing the future of the NHS with mummifying it. Where current institutions and models of care can and should be improved, we must develop and deliver new ways of supporting people to stay well. The NHS is more than its estate, it’s about ensuring that the needs and priorities of patients and communities transform the care they receive from skilled caring professionals, and that this is all underpinned by the intelligent use of data and technology.

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For far too long the constituent parts of the health and care system have failed the British public with our inability to work together above organisational, professional or sector interest. For the first time in my career I sense that this is beginning to change, with a dawning realisation that the current challenges we face apply across the health and care system: across geographical borders, professional boundaries and sector specifics.

The solution therefore is dependent on the constituent parts of the health and care system working together at a local level to deliver the improvements in health and wellbeing that communities desire and deserve.

Courage and leadership

The vision set out in the “2015 Challenge” manifesto is the imagined future shared by a powerful health coalition, which is demanding our national politicians put in place the necessary plans to enable us to build this future – together with the public – during the next parliament. There are already glimpses of that future visible in the health and care system today, but it is not evenly distributed and the population is deserving of our divine discontent in putting that right.

‘The NHS will require leadership from clinicians, managers and patients of the like we have never seen before’

At the end of the next parliament I will be entering the twilight of my career. But while I remain within the NHS I will seek to do whatever I can to ensure that the values enshrined in the NHS constitution do not simply survive but experience their full expression.

My fear is that if we don’t seize the initiative to move the NHS from good to great in that period then we will be looking to salvage what we can from the wreck. The NHS might survive but there are likely to be increasing calls from the taxpayer in pulling themselves out of its misery.

Loud voices

Preventing this from happening, and I genuinely believe we can if we act now, will require leadership from clinicians, managers and patients of the like we have never seen before. It will also require courageous political leadership, with a collective ambition that extends beyond car parking charges, contracting and hospital food.

‘None of us can afford to see the NHS sacrificed on the altar of ineffectual political ambition’

We need politicians who will speak out loud and clear on the fundamental challenge of ever changing needs among the electorate and what plans they have to support us in bringing about the necessary changes in care models at a time of tough financial constraint across the health and care system. None of us can afford to see the NHS sacrificed on the altar of ineffectual political ambition.

I think that this might be the last chance we have to bring about the change we want to see. The 2015 Challenge manifesto suggests that I am not a lone voice on this. The coalition that it represents is determined to do their part in bringing about change and to hold the politicians to account for playing their part.

I hope that in five years we are not in a position to have to say “we told you so” and that what we value so much about the NHS was lost on those politicians’ watch. But if we are, I hope that a growing coalition of health and care professionals and organisations will join me in doing just that.

Dr Johnny Marshall is director of policy at the NHS Confederation