Coalition’s uncertain future threatens NHS renewal

But as the new coalition beds down, uncertainty about its longevity will persist for many months - and possibly longer.

There is the danger of what one chief executive described as the “toxic uncertainty”

“So what?” some managers appeared to conclude. One, commenting on Twitter last Friday, demonstrated significant sang-froid: “All emails read, consultants happy, wards under control and a parliament not in a position to change the NHS supertanker course. Bliss.”

Unfortunately for many managers the reality of delivering efficiency savings during this period of uncertainty is likely to be much more painful - especially those who have understandably held off from pushing difficult decisions.

Let new Health Secretary Andrew Lansley and his team be aware: there are a large number of NHS organisations in areas including - but not limited to - London, much of southern England and Yorkshire, which are staring down the financial barrel.

Most will be able to struggle on but the pain being stored up for 2011 is significant.

Without action there will come a time soon when these organisations will either have to be bailed out or begin to withdraw services. Either prospect should be unpalatable to any government.

Then there is the danger of what one chief executive described as the “toxic uncertainty” about an organisation’s future undermining staff confidence and commitment.

Losing key clinical staff to more “secure” organisations will be managers’ key concern, but the service as a whole needs to ensure it can also retain senior management talent. Right about now, private sector opportunities are looking increasingly attractive, as is - for older managers - retirement or voluntary redundancy.

There is a significant danger that the next six months could see a flood of senior health managers departing the service. Without wishing to be ageist, it will be the older managers who will be the greatest loss, if only because their working lives include the tough times of the 1980s and 1990s.

A test for the incoming administration should be how many of the 1,000 top leaders identified by the Department of Health (Leadership supplement, 4 March) are still in post a year from now. Stability is not just key for governments and economies.

So how should managers act now?

To state the obvious first, clinical engagement becomes even more important.

But do not give up on the politicians: many MPs - and local councillors - are new to the job. All they know about the NHS will be have been learned in draughty halls during “save our A&E” meetings. Now they have been elected they will want and need to be properly educated. The last thing a new parliamentarian needs is his or her local health services going belly up during their first term. They will be very grateful if you can help explain the challenges the NHS faces.

Any chief executive who would like a free online subscription for their new MP should get in touch with me.