So the race is on to find Sir David Nicholson’s successor, with the only certainty at this stage being that almost everyone will have an opinion on who that should be.

‘Please, no more reports, leadership programmes, pilots or centrally driven initiatives’

But let’s put the betting to one side for now and focus on what is perhaps the more important point of the challenges facing the new CEO. I’m not thinking about the usual headline stuff but those things that will have a longer-term, all round impact on NHS delivery and reputation. In other words, cultural change, changing public expectations, managing rising demand and smarter financial management. I think there are only three interrelated challenges that would fit my criteria:

Reinvent emergency care. This is not the first time there’s been a so-called crisis (I recall at least two summits in the latter part of my time in the NHS) and probably not the first time there’s been a task force. I can only hope that what emerges this time will see the NHS take a huge leap over the current srrangements to create what the public is probably looking for, namely an integrated emergency and primary care service.  

Set challenging annual commissioning targets (with no apologies for the “T word”) to take long-term conditions management out of hospital. Like the first challenge this will require, among other things, workforce innovation, much more self-management and patient engagement supported by the use of relevant technology. This, after all, is what is happening in other sectors such as retail, banking and leisure, so why should taking greater personal control of, and responsibility for, our healthcare be any different?

System management. I mean doing it rather than talking about it. Please, no more reports, leadership programmes, pilots or centrally driven initiatives. System management means learning to collaborate and partner using shared resources, realigned incentives and tariffs to match. It means freeing up diaries to focus on relationship management, probably the one principal lesson the NHS can learn from the private sector. It does not mean creating yet more new organisations − this is not about structures but behaviours and a belief that things have to be done differently for patient/client satisfaction and organisational success.

‘The NHS often feels more comfortable with a scatter-gun approach to objective setting in which everything becomes a priority

Each of these challenges, whether on their own or taken together would begin a process of transforming and innovating the NHS. By focusing on fixing and improving services seen as having the greatest impact on the majority of consumers, delivering the challenges would begin to restore public and political faith in the NHS after what has been a turbulent time.

This doesn’t mean stopping work on everything else. But if we’re honest, the NHS often feels more comfortable with a scatter-gun approach to objective setting in which everything becomes a priority. This is as much a governmental issue as a managerial one.

Finally, focusing disproportionate effort on the above challenges would also help tease out responses to other long-standing and unanswered strategic questions such as: what is the future role of the district general hospital? If this is not addressed they will be squeezed into an inappropriate shape between primary and tertiary care. 

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