Let's not kid ourselves, the NHS has to shape its own future

When the coalition was formed in 2010 and took pride in saying they were protecting NHS funding, we all knew that after years of real terms growth it was going to be tough.

• Confederation chief calls for 10 year NHS funding settlement
• More analysis and opinion at HSJ’s Comment section

And let us not kid ourselves that there was more money on offer elsewhere; Labour went into that election refusing to guarantee they would not cut the budget.

Back then there was no shortage of people saying the NHS could not survive five years on flat real terms funding.

We have so far because caring, committed clinicians and managers have bent over backward to keep services delivering often great care.

Discussion at last

All this has been achieved, while we have seen a long overdue focus on safety, quality, engaged staff and the importance of having patients involved in every decision about their care.

We have been pushed to this by Francis, Berwick, Keogh and West, among others

‘Back in 2010 there was no shortage of people saying the NHS could not survive five years on flat real terms funding’

At last these issues are being discussed by boards in a way that recognises that the NHS is made of people; and that quality and finance are two sides of the same coin.

So we should all be proud that the NHS is in as good shape as it is, while facing up to the fact it is also at its most challenged. We, along with a coalition of others, have published the 2015 Challenge Declaration, setting out very clearly the scale of the challenges we face.

The key question now is what we do about it.

The service we want to see

There are those that will say we are doomed and will paint all sort of apocalyptic futures, without any sense of their being an alternative.

Others will say that we just need more cash, or indeed a different way of funding the NHS. I do not think any of these are adequate.

It is important to say what might happen if we do not make the change that is necessary and it paints a bleak picture.

‘If we can set out a vision of what a future healthcare service looks like, we can also work out what needs to happen for us to get there’

For the sake of every citizen who uses the services and every staff member within it, it is vital that we also paint a vivid picture of the alternative: the health service we want to see.

I think there is a strong developing consensus of what it looks like; it is based on working on the impact that place has on health; seeing people as assets not problems; and using information to drive improvement.

This brings a huge focus on:

• Dealing with the causes of preventable ill health like smoking, drinking, obesity and inactivity;
• Supporting people to care for themselves using technology at scale;
• Intensive, personalised care for the small proportion of the population with multiple long term conditions that use the most resources, much of which will be outside hospital;
• Hospitals must be “more local” and still be clinically and financially viable; and
• World class specialist centres that save lives and drive innovation.

If we can set out a vision of what a healthcare service of the future looks like, then we can also work out what needs to happen for us to get there. If we can do that, the future is in our hands. And if the future is in our hands, we have a responsibility to be hopeful about the future.

Radical change is needed

I am hopeful about the future because I have seen what we have done already and I know we can do more.

NHS England chief executive Simon Stevens in his HSJ interview last week said that parts of the NHS will need to be completely reinvented, and that he recognised deep seated structural problems.

But he did not set out a national blueprint for another upheaval of the organisation of health services.

Since the NHS was established, there have been numerous reorganisations of the way that we administer, manage and transact health services. The way we provide health services has remained essentially unchanged.

‘The way we provide health services has remained essentially unchanged’

To achieve the sustainable healthcare service we all want we will have to radically change how we provide care.

As the NHS and care services meet this week at NHS Confederation conference, there are two things I would like us to do:

The first is to stop thinking that politicians - or indeed national leaders - are going to somehow give us all of the answers to a sustainable healthcare service. Certainly there are things we must ask of them to enable us to make the changes we need to make.

These specific asks are few and important, like clarity on the money. But they are put into the shade by the biggest ask of all: give us the space, the support and the alignment of system tools to transform services in our localities.

Second, I would like us all, individually in our organisations and in our communities, to take our chance to shape the future. It will not be easy and some will stand at the side and say it cannot be done. It will need engagement with staff, patients, the public and our partners, the likes of which we have not seen before.

Testing times

‘We’ve managed to cope with challenges despite the politicians and national leaders, not because of them’

I am hopeful for the future because I have seen how we have managed to cope with the challenges we have faced already. We have done it, at times, despite the politicians and national leaders, not because of them.

The coming years will test our resilience like no other.

If we can find meaning in what we do, face the reality of where we are and ask for the right help, we will succeed and shape a future NHS that works.

There really is no alternative, and the NHS Confederation will be at the heart of helping to make this a reality.

Rob Webster is chief executive of the NHS Confederation