In the last few years, rather than address what are clearly structural failings, the NHS has had money ploughed into it.   I suspect the true level of the funding gap has been under egged and £15 – 20 billion is possibly a conservative estimate.  

No one would dispute that both the quality and quantity of care provided by the NHS has improved, but bearing in mind the amount of investment we really should have done better.  

Value for money should not be unpleasant words in healthcare.   Better VFM means more people could perhaps have received treatment and we could have improved outcomes.   We know that the NHS significantly lags behind the rest of the public sector in VFM.

Best practice evidence is out there in abundance but many don’t come anywhere near achieving it.    Someone said to me recently that they blamed the banks for the financial situation in the NHS.   Some people seem to blame the fact that the commissioning function hasn’t done what it set out to do.  Some people blame managers.  Some people blame the doctors.  Some blame the government. No doubt some blame the patients.   It’s clearly not the responsibility of one group, moreover a combination of factors and besides, blaming isn’t going to help nor will it deliver.

On a human level I feel for everyone who is at risk at the moment; anyone whose job is uncertain or who has already been released or been given notice and I feel for all those who don’t really know what is happening to their organisations or when.  It is horribly unsettling and for some immensely stressful.   All of us should be mindful that these are unprecedented times and none of us should rest on our laurels.   

So whilst I feel for those directly affected by the proposals set out and whilst I am as nervous as the next person about the scale and speed of the proposed changes ahead, one thing is for certain, I definitely think the NHS needs a shake up. 

The approach until now seems to have been to avoid dealing with the challenges by throwing money at them.  This money hasn’t necessarily translated into improving outcomes, of course in a number of cases it has, but overall it has meant other things e.g.  higher wages for some (which would perhaps be acceptable if productivity had increased alongside) and new buildings (some of which we possibly do not need).

Whilst there are many, many things we are justifiably proud of with our health system, we should be ashamed when public money is spent inefficiently or on the ‘wrong’ things.  This is hard, unpalatable and unpopular stuff.  I know I tend to look at things very simply, but we over complicate often to a point of paralysis and we waste money.  

David Nicholson, in his letter to NHS CEOs, highlighted the actions that need to be taken now nationally, regionally and locally.  He also outlined what NHS leaders should be doing. Aside from the fact that NHS leaders should probably have been doing many of the things listed anyway, the underlying point is that super duper leadership is needed now.   That’s ok, but some people simply are not super duper leaders.   We have some absolutely fantastic leaders in the NHS, they are inspirational and I have no doubt that they will embrace these changes from their various positions and implement amazing things.  There are also some fantastically mediocre leaders out there who will not or won’t be able to lead at the level required.    Furthermore, some will go into self preservation mode because of the uncertainty around the future.  

No disrespect meant, but David, a letter from you asking people to lead isn’t going to make people lead if they didn’t or couldn’t before.   Senior does not equal able to lead; I have met some phenomenal leaders who are, comparatively speaking, in very junior roles.   Some senior people could learn something from them.   Having been in the system a long time does not mean able to lead.   Leaders need to have immense courage in the current climate.  Not just a lot of courage, immense courage.  

I go back to one of my first blogs from about a year ago where I asked people to be honest.  I ask again.   How many of us know people who do not perform?  How many of us can list jobs which are not necessary or don’t provide or contribute to value for money or value for patients?  How many of us know some excellent people but who are probably in the wrong job?  Be honest.   

We need to look at the current situation through new eyes – the challenge for all of us is to open our eyes rather than keep them firmly shut pretending this isn’t going to happen.   Who knows whether all these changes will happen exactly as they have been set out, after all we are in the middle of the consultation process, but one thing is certain, the NHS is going through one of its most radical changes.   If it improves care for patients and costs less then we should be happy.  Many are sceptical and will say that it probably won’t but that’s the leadership challenge and highlights why immense courage is needed.   Whatever is decided post consultation period we have to make it work.