What the NHS Improvement chief executive must do first

“Join the team and make a difference” was a successful NHS recruitment campaign that reinforced the role of all of the staff in the NHS in the treatment of patients.

If there is one clear change we must see under Jim Mackey’s leadership of NHS Improvement, it is a commitment to being part of a leadership team across the arm’s length bodies, a team that helps bring about the biggest changes in the history of the NHS.

‘In a world where we speak often of horizontal and vertical integration, we can now consider both’

NHS Improvement is not Monitor or the NHS Trust Development Authority. It is something new entirely - an organisation that can get alongside the provider sector and help support leaders to make the changes that we need in service delivery.

In a world where we speak often of horizontal and vertical integration, we now have the opportunity to consider both – NHS Improvement working horizontally with arm’s length body chief executives, and Department of Health and vertically with local NHS and local government leaders.

Easier said than done

There are many who will be offering Jim advice on his new role – he will know how he wants to do the job. What I would point to is an opportunity to address fundamental issues that affect NHS Confederation members and blight our chances to deliver better care.

With its broader remit, we need an organisation that focuses on quality in the context of current finances rather than one that obsesses about finances to the detriment of quality. The evidence from places such as Wigan, Jonkoping and Intermountain is that this approach drives engagement and sustainable delivery. 

‘Short term, ugly interventions to reduce costs stymie transformation and disengage staff’

Aiming for this is easy to say, is counter cultural and something that will take years to perfect. The need to do so cannot be ignored.

The immediate pressure that may deflect us will be finances in 2015-16. Widely reported stresses in provider finances, the fragility of social care and the reduction in public health spending are problematic. A national approach to managing service debt this year, backed by a medium term plan and a credible spending review settlement need to be secured.

The alternative is that we focus on short term, ugly interventions to reduce costs. These stymie transformation and disengage staff. There is a better way – and the means with which to secure it. Engage the service, get alongside them, make the planning system work for the medium term and find a collective way through this year.   

Come together

Our work with the Academy of Medical Royal Colleges on decisions of value shows that there is a shared managerial and clinical desire to see finance and quality concerns as two sides of the same coin. Jeremy Hunt’s focus on safety and transparency could, just could, mean we have a chance in securing a new and better approach.

Some honesty about safe staffing would be a particular area that would benefit here - the current arrangements are playing a significant role in driving up deficits with a commonly expressed view that ratios, rather than detailed discussions on evidence of efficacy, are driving decisions.

We know the best way to ensure we have the right staffing levels is not through such arbitrary ratios but by empowering clinical leaders in their organisations to set appropriate levels. NHS Improvement is well placed to tackle this and ensure staffing levels are determined in partnership with staff and the people who use those services.

‘Current safe staffing arrangements are driving up deficits’

Of course, if the Care Quality Commission is already looking at resources as well as quality there is a risk of duplication and confusion. 

There is now a chance to set out the role of NHS Improvement and how it will work with the other national bodies. The arm’s length bodies will need to work more closely together to help NHS leaders provide high quality care – 96 per cent agreed with this in a member survey we conducted earlier in the year.

We need a joint team of NHS arm’s length bodies, working with their peers to agree who does what and how they will collectively provide system leadership. Jim’s strong background, in partnership working in the north east, puts him in good stead for this.

First things first

We live in a “post-Five Year Forward View world”, with a pressing need to reshape care to better meet health needs. NHS Improvement will need to respond to that. In Jim they have someone with a strong background in transforming services.

But he is not alone – with NHS and care leaders from Cornwall to Cumbria showing how this is done. NHS Improvement needs to empower local leaders to be bold, giving health systems greater freedom to make radical changes to care everywhere. 

‘Jim with his track record can be a catalyst for a different conversation’

One quick decision that would help facilitate change would be to take the foundation trust pipeline and unblock it. This has been a source of uncertainty and often a distraction from efforts to redesign care at a large scale.

We urgently need this resolved so trusts can focus on what matters. I would urge NHS Improvement to be bold and find a way to give all trusts a temporary licence so that we can get on with transforming care and thinking about the next phase of organisational form.

Finally, if NHS Improvement will be able to realise its goals then we need the right local leaders in place. Sadly the toxic stew of pressures we face are making it harder and harder to retain good leaders.

As I have said before, we need to stop the revolving door. By modelling the right behaviour and supporting leadership in the NHS, all of the arm’s length bodies can make a difference. Jim with his track record can be a catalyst for a different conversation and a different approach.

We look forward to working with him and his colleagues at NHS Improvement as they join the team and make a difference. 

Rob Webster is chief executive of NHS Confederation