NHS England must combat the growing tide of cynicism

Scepticism should be the default setting when considering plans hatched by governments and national agencies – most fail to achieve all their goals.

However, the idea the centre should not use democratic legitimacy, a cross-system view and unequalled access to expertise to paint a picture of a better tomorrow and speed the service’s journey towards it would be a dereliction of duty, damaging to the NHS’s fortunes.

‘The message that local services are masters of their own destiny is either not widely believed or has not got through’

The relationship between the centre and service has always been marked by mutual suspicion, regardless of the structures in place. This is one of the few negatives of a monopsony system, which needs to be balanced against its many advantages and factored into decisions and strategies.

But there are times when scepticism shades into cynicism and begins to actively interfere with the NHS’s ability to achieve its ambitions. It is not that dark yet, but it is getting there.

Going local

The lengthy online argument that resulted from HSJ’s exclusive that West Hertfordshire chief executive Samantha Jones would be joining NHS England was an overt manifestation of this rising gloom. At the heart of this debate is the role of NHS England. The long honeymoon deservedly given to chief executive Simon Stevens had pushed this critical question into the background, but it has now returned to the agenda.

‘Stevens has been unable to find a provider chief executive for the role of director of specialised services’

Mr Stevens’ vision is for NHS England to identify the best solutions available to the NHS and then facilitate and incentivise local services to select and deliver the most relevant option. That is why the NHS Five Year Forward View, was not a “plan”. Yet the message that local services are masters of their own destiny is either not widely believed or has not got through.

One of the tactics adopted by Mr Stevens to tackle this is to attract those with frontline credibility into senior roles. He has achieved that with the appointment of Ms Jones and fellow team member Sir Sam Everington – but elsewhere he has uncharacteristically struggled, being unable to find a provider chief executive for the role of director of specialised services, for example.

Credible leadership

The flow of leadership talent has been away from the centre (and, indeed, commissioning) and towards providers – a common trend in times of uncertainty and a recognition of the direction of policy. Another factor of anxious times is the tendency for leaders to sit tight – welcome given the butterfly lifespan of many senior NHS executives, but a challenge for organisations needing an injection
of talent.

‘What NHS England and its partners need to do is to better define their relationship with the service’

But credible leadership apart, what NHS England and its partners urgently need to do is to better define their relationship with the service. This, ironically, has as much to do with clarifying when – and how – they will act as a system manager, as it has to do with making Mr Stevens’ desire for local self-sufficiency a reality.

Criticism of the current, often confusing, arrangements is as much about the centre’s lack of desire to get involved in difficult decisions as it is about any overt interference.

NHS England specifically also needs to demonstrate how it will allow the work of leaders with recent and relevant experience to directly influence policy and not have their sometimes inconvenient truths smothered in an attempt to steer a “steady ship”.

An elegant operator like Mr Stevens will dislike the “noise” generated, but he should accept it as way to prove the dead hand of the centre is no more.

HSJ comment boards are never going to fill up with praise for central bodies, especially when resources are so tight, and some tension is always relevant between those with an oversight role and organisations at the sharp end.

But a clearer compact with the service would engender a more positive dialogue and allow a greater focus on the real challenges ahead.