What were your defining moments of 2013 for the NHS? There were several contenders, but for me there were two events that bookended the year.
The first was the Francis Report published in February. This wasn’t for its monumental nature and vast number of recommendations but it was the moment when quality decisively displaced finance as the overriding imperative for Boards and managers.
The consequences of this are unfurling from the Keogh review of 14 acute trusts, to Care Quality Commission (CQC) inspections and the focus on nurse staffing in hospitals. All this will have major effects on the dynamics of the service for years to come. We are tracking the response of trusts to the Francis Report and will publish the results of our research in February, one year on from the original.
The second was the news that the Prime Minister has a weekly briefing on the state of the nation’s A&Es and that the Secretary of State has been telephoning Chief Executives of trusts that have been struggling to cope.
But as we go further into the year, two powerful scenarios may begin to emerge
It is no accident that this news came out. It symbolises both the Government’s anxiety about the ability of the NHS to manage the pressures on something the public rightly regard as an absolute touchstone of the service, and their determination to show they are on top of it.
It also perhaps answers the question of ‘who is in charge?’ There is only one answer, just as there was when the NHS Executive was set up and sent to Leeds in 1990 and then discovered its operational ‘independence’ foundering on the ambulance drivers’ dispute.
Still, as we move into 2014 and the centenary of the start of the First World War, better for the politicians to be seen to be closely involved and concerned than to suffer what happened to Asquith the then Prime Minister.
Allegedly, he used to spend Cabinet meetings translating dispatches from the front into Latin verse, believing there was little else he could do with them. It was that and other similar behaviour that led one society hostess politely to ask by way of social chit chat ‘Do you take an interest in the war Mr Asquith?’
I won’t make any predictions for 2014, other than a rather dull ‘more of the same’ and ‘muddling through’ for health and social care, and a very safe one that the performance of the NHS will come under increasing scrutiny in the run up to the 2015 election. What are its prospects? Is it better under Labour or the Coalition and, in a twist fuelled by the Scottish independence referendum in September, in which country?
Our forthcoming publications on access to emergency care, the impact of cuts in social services, the financial performance of the NHS, the development of clinical commissioning groups (CCGs), and our assessment of NHS performance across the four countries will help you sort out some of the facts.
But as we go further into the year, two powerful scenarios may begin to emerge.
The first is that it will begin to look like health and social care will start to transform as CCGs and health and well-being boards and NHS England, itself under new management, get into their stride, respond to the Call to Action and prepare in innovative ways for the Integration Transformation Fund that comes on stream in the following year.
The second is of course the opposite. Keeping up the First World War theme, the NHS will find itself deep in the trenches, besieged by an increasingly strident press, and fighting over hard won ground on waits for GP appointments, A&E pressures, waiting times, deficits, staff morale and reconfiguration arguments. And it won’t be over by Christmas ’14 either.
McKeon A (2013) ‘Defining moments of 2013, predictions for 2014’. Nuffield Trust comment, 16 December 2013. https://www.nuffieldtrust.org.uk/news-item/defining-moments-of-2013-predictions-for-2014