Politicians aren’t the only cause of the NHS’s uncertain future

Blame the government − or indeed any politician: if you want to win a round of applause at a health service event or get a free drink in the bar afterwards, that is all you need to do. The NHS’s political masters are commonly seen as the root cause of the service’s ills. They either fail to provide enough money or lack the cojones to back the changes needed to deal with the lack of it.

The NHS Confederation is attempting to corral political support for service change by getting the major parties to sign up to a “deal” that would prevent them campaigning against reconfigurations that had support from commissioners and local authorities. It is a sensible move, but even the most obedient candidate is likely to abandon the party whip once the local paper asks, “Why does X want our hospital to close?”

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If you want to win a second round of applause (or secure another drink) you can always “blame the regulators”. Few are content with being scrutinised - however much they recognise it as being necessary. This discontent tends to erupt when a regulator makes a mistake (as the Care Quality Commission knows) or is seen to overstep the mark.

Monitor’s recent pronouncements on how the NHS should meet the efficiency challenge were greeted with understandable exasperated cheek blowing and scoffing from those within the service struggling with day to day challenges − although the barbs against learning from overseas carried unwelcome taints of the arrogance the NHS can sometimes be prone to.

Whether it is Monitor’s application of competition rules or the CQC’s inspection teams crawling over blameless hospital trusts so politicians can assure the public “something is being done” - the NHS response often is, “Why can’t you just leave us alone and let us fix these problems ourselves?”

Crisis of faith

But is all this kicking upwards partly a way of disguising the fact there is no real consensus in the service about the best way forward.

One of the reasons politicians are so nervous about backing local service change is that they know there is a good chance at least one prominent clinician will break ranks.

‘The leaders of some of England’s foremost hospital trusts are openly sceptical of the shift of resources to community settings’

But even among the service’s leaders there is often too little shared vision. The placing of GPs in lead commissioning roles has intensified the focus on primary care. More − and better paid − GPs is the answer, with even the CQC apparently about to “campaign” on this front.

But few providers appear to place much faith in this solution. The leaders of some of England’s foremost hospital trusts are openly sceptical of the shift of resources to community settings − arguing that the evidence for cost savings is thin at best.

Failed experiement

Hospital care is in demand for good reason, they say. Some of the boldest argue their influence should be extended − even to take responsibility for inadequate primary care services.

‘Politicians and regulators must take their share of the blame, but we all let ourselves off lightly if we think that is the only reason the future appears so uncertain.’

They are also firm in the belief that commissioning is a “failed experiment” − something that politicians will soon realise and it is clear the top hospitals have already been influential on Labour’s “preferred provider” plans.

Of course, there are myriad examples of good local collaboration, but these often happen despite a stream of objections and take many years to deliver any kind of benefit as a result. Many more ideas die on the journey as vested interests of all kinds take it in turns to ambush them.

As Dame Ruth Carnall wrote on HSJ’s website last week, “Collaborative models of leadership will often break down in the face of conflicting pressures.”

Politicians and regulators must take their share of the blame, but we all let ourselves off lightly if we think that is the only reason the future of the NHS appears so uncertain.