Mackey: It's pointless to argue we should have got more

This funding settlement is good news for the NHS

In the context of the general economic situation and funding settlements for other public services, this announcement must be widely recognised, and accepted, as significant extra investment. It was never going to be enough to make every problem go away, and we would always want, and need, more.

However, we must ensure that every penny is used wisely and gets to front line patient services to deliver as much improvement as is humanly possible. We, as leaders, have the responsibility that comes with this money to deliver that.

Having worked at national level, I know how hard fought these battles can be, and as a service we need to give full credit to those who have secured the extra investment the NHS desperately needs. I would say that it’s pointless continuing to argue whether we should have been given more money – we’ve got what we have got now, so let’s not waste it.

Competing priorities

It is really not going to be easy as we know we are all juggling lots of competing priorities. One of the most difficult tasks I found working nationally was balancing between priorities that we all know are vital – recovering NHS constitutional performance standards; eliminating the provider sector deficit; expanding the workforce; solving our backlog estates maintenance issues; investing in IT; developing community services and primary care; integrating health and social care; delivering better cancer and mental health outcomes; and driving world beating innovation in areas like genomics – to name just a few.

All involved need to contribute fully and openly – this is a big opportunity so let’s not waste it

We need, and want, to make improvements in all of these areas, and importantly, take the strain off our staff. These are all important but we have to balance between them and make sure that we make the choices and agree the priorities together, with the facts and objectivity that people should expect from us as leaders. We must avoid overstretching and overcommitting again.

We also need to avoid the dreaded fudge factor that drains energy and impact so much. A plan that many can’t understand or deliver, isn’t a plan….

This much needed extra investment does offer the opportunity to break the cycle of missed financial and performance targets. However, to realise that opportunity we have to be ruthless about the priorities we now set, be realistic about “the ask” we now make of our frontline staff, and be clear about “the promise” we make to the patients and communities we serve.

That’s why the national planning process we are now entering is so important. I was pleased to hear the prime minister make it clear in her speech that this plan has to be created with the full engagement of the service, patients and staff. This needs to be real engagement with views genuinely listened to and acted upon. All involved need to contribute fully and openly – this is a big opportunity so let’s not waste it.

It’s difficult to hold people to account if the task they are being set is impossible to deliver and they have no hand in its creation. That’s why, as a trust chief executive, I believe it’s particularly important that trust leaders should be able to input directly, and through NHS Improvement, our sector regulator, and NHS Providers, our membership organisation, into the plan.

Given past experiences, if trust leaders are to own the plan and be accountable for it, they must be deeply involved in its creation and be able to assure themselves that it’s deliverable.

So, what will be key now is how this engagement process works and we will all gain confidence from seeing this described very soon, alongside confirming the people involved and the style in which it will be conducted.

We must avoid impossible plans

This is difficult stuff – we need plans that are stretching and difficult to achieve whilst maximising improvement. But we also need to avoid plans that are impossible, or built on dodgy or overoptimistic assumptions, or plans that are possible for only a small minority.

We need a set of objectives that most can deliver against. This money gives us this opportunity to do that but this next stage is key and we must all pull together to make that work.

We all want to see a service that is fit for the future – the next 70 years will see the service transform care in a way that was inconceivable when the NHS was created.

We now all have the responsibility to develop and agree a plan that we can all get behind, believe in and deliver

We also all want to see improvements country wide in key constitutional standards, financial stability, better winters than the last few, improvements in cancer performance and outcomes, better access and performance in primary care and mental health and, importantly, better and consistently high levels of patient and staff satisfaction. With this investment and this involvement in any plan, comes the responsibility to deliver it.

We all know that the NHS delivers more, pound for pound, than any other health system and I am sure we will continue to do that.

Healthcare is a human endeavour. The NHS is built upon the efforts of over one million dedicated staff and a population that loves it – quite rightly. They all, and we all, need hope that things can improve and that outcomes, standards and experience are better in five years than they were yesterday.

This money gets us on the pitch. We now all have the responsibility to develop and agree a plan that we can all get behind, believe in and deliver.

Let’s get on with it.