How a new government can ride the 'crisis' tide to effect change

Even allowing for the gloom brought about by pre-election shroud waving, there is no doubt the NHS is in a grim place.

‘A clever new government should exploit its momentum and the atmosphere created by “NHS crisis” headlines’

The days following last week’s editorial on the provider sector’s financial collapse saw a £16.5m deficit revealed at what is arguably Britain’s leading hospital, while the provider sector overall expects to finish the year an extraordinary £823m in the red.

The only reasonable reaction to the next government’s task in tackling the NHS’s myriad, competing problems is “heaven help them”.

But counsels of despair are of little use. Sensible policy makers should be thinking along the following lines.

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Use wisely

The first resolution should be to use the period immediately after the general election wisely. The focus must be on issues that undermine the NHS’s future and not, as in 1997 and 2010, on re-fighting the ideological battles of the preceding five years.

Parliamentary arithmetic will complicate the task, as no party is likely to have a compelling electoral mandate. But a clever new government should exploit its momentum and the “something must be done” atmosphere created by “crisis” headlines to establish greater room for manoeuvre.

‘Under almost any likely scenario a new government will not be enough to cure the NHS’s money blues’

It should relax, but not abandon, access targets – moving the 18 week elective care target to 26 weeks and extending emergency waiting times so they are aligned with those in the sainted Scandinavian healthcare systems.

This should not undermine clinical outcomes and would ease priorities towards service development and away from hamster wheel performance delivery. That the existing targets are enshrined in the NHS Constitution should not prove too much of a challenge.

A new government must find more funds for the NHS, but under almost any likely scenario it will not be enough to cure its money blues. Nor will the renewed focus on efficiency and cost variation – crucial as it is.

Need for price investment

Private investment will also be required. The launch of the first NHS social impact bond is an interesting straw in the wind (hsj.co.uk/social-impact-bond), as is the use of private funding in the development of Cambridge’s health campus.

It also worth remembering that local authorities are much more relaxed about and experienced in attracting non-state support.

Last week, HSJ called for urgent payment reform. To this challenge, we would add overhaul of provider regulation.

Tools such as the “failure regime” are entirely unsuited to a situation in which large numbers of providers need cash support. Maintaining this fantasy is consuming a huge amount of leadership time that could be better spent.

Policy makers and system managers should instead focus on the organisations that can lead the NHS out of this difficulty.

‘This picking of winners should extend to protecting the “vanguard” cohort of new care models’

The review of possible provider models by Sir David Dalton still offers the most cogent blueprint for existing organisations.

However, it is based on the premise that the strongest players can be incentivised to extend management control over weaker counterparts. If these bigger providers are also sliding into deficit, it is hard to see how this scenario could gain any traction.

So the desire to spread any available cash around must be resisted. Those able to lead sustainable development within a healthcare economy must be given the chance to exercise their influence.

This picking of winners should extend to protecting the “vanguard” cohort of new care models and the larger group of “fast followers” that are preparing their own plans. This means rapidly identifying any duds whose ability to implement falls short of their ambition, and working out where discretion is the better part of valour.

But it also means sticking with best bets through periods of controversy and not watering down their radicalism. Failure could fatally undermine the NHS Five Year Forward View and devising a plan B would create crippling delays.