The new health secretary will face an uphill battle

A new Parliament represents a new beginning and a time to set different priorities. So what’s the task for the NHS over the next five years, and what should be top of the new health secretary’s agenda?

The NHS task is best summarised as “stabilise to transform”: the service can’t transform to deliver new care models until its performance and finances are stabilised.

Stabilisation without transformation would lock the NHS into an unsustainable model, which won’t deliver for patients in the medium term. Both are needed.

‘Stabilisation without transformation would lock the NHS into an unsustainable model’

As the latest King’s Fund and Health Foundation reports show, NHS performance and finances are under real pressure.

A slew of NHS constitution acute and ambulance targets have been missed over the last 12 months, and performance pressure on mental health and community providers is just as intense. A provider sector surplus of £593m in 2012-13 is likely to become a deficit of around £1bn in 2014-15, and over £2bn this financial year.

Top of the agenda

Stabilising and then improving NHS performance and finances are vital to safeguard quality of care.

The first item on our new health secretary’s agenda should therefore be to work with local and national NHS leaders to create a stabilisation plan for performance and finance.

‘Ministers should set a realistic timeline to get back to target delivery and financial balance’

This plan needs honesty and realism. NHS performance and finances can often resemble Sisyphus’s ball - they go downhill very rapidly and it can often take 10 times as long to push the ball back to the top of the hill, with corresponding effort.

Ministers should set a realistic timeline to get back to target delivery and financial balance: three years doesn’t seem outlandish.

Managing tight funds

NHS funding should be the second agenda item. Of course the service hopes that a new health secretary will be able to secure extra funding for NHS and social care for 2015-16 and the rest of the next Parliament.

But, as the Institute of Fiscal Studies analysis of the party manifestos shows, government finances will be extremely tight for the first half of the Parliament.

‘Managing the NHS is a three legged stool’

The spending review will set the funding envelope and central to this will be the level of efficiency savings the service can realistically deliver.

The new health secretary must also decide how to answer the Barker commission exam questions:

• how to build consensus for higher long term health and social care funding levels; and
• how to integrate the two sectors’ entitlements and funding streams.

The last Parliament showed the direct links between finances and workforce.

Managing the NHS is a three legged stool: quality, access and finance must balance evenly.

The primary driver for provider finances going awry was the additional unfunded £1.5bn for staffing levels to meet new quality requirements.

One direction

The third priority for the new health secretary must therefore be to establish a clear strategic direction on workforce, set by the financial envelope.

This steer is particularly important given the seemingly unaffordable NHS workforce manifesto pledges.

‘Our new health secretary needs to ensure the service is clear about how it delivers the transformation vision’

Should provider boards start freezing vacancies because money will be tight, or prepare to recruit extra staff because funding will be available not only to close the existing demand/funding gap but to expand the workforce?

We also need a clear national plan to tackle the supply of qualified staff and key staff shortages, so providers can act locally including reducing agency spend.

Our new health secretary also needs to ensure the service is clear about how it delivers the transformation vision set out in the NHS Five Year Forward View.

What are the transformation priorities? How will transformation be funded? How will it actually be delivered and how quickly? All these questions need answers.

Be clear

Underpinning all of this will be the health secretary’s final priority: to develop the NHS accountability, regulation and system leadership structure.

There is widespread recognition that the 2012 Act has left us with a confused, unclear and inadequate structure. Responsibilities need to be clearer and overlaps eliminated.

‘Responsibilities need to be clearer and overlaps eliminated’

Stabilisation requires an appropriate accountability regime; transformation will require the arms length bodies to understand that they need to support and enable local health systems, not just regulate them.

Since “stabilise to transform” is the task facing the NHS to protect and improve patient care, the health secretary’s five priorities should therefore be:

• provide the conditions to allow providers to stabilise their performance and finances;
• secure the right settlement for the NHS and social care within the forthcoming spending review;
• be clear on NHS workforce strategy;
• develop clear lines of accountability which respect the autonomy of NHS provider boards within the context of effective regulation and system leadership; and
• oversee NHS transformation.

Chris Hopson is chief executive of NHS Providers