As major reforms to the NHS in England go live next week (1 April), a dozen of the country’s most senior managers working in the NHS over the past two decades have given their verdict on the Coalition Government’s reforms, the factors they believe are critical to safeguarding the service’s future, and what their successors most need to know.
Almost universally, the group of NHS chief executives and other health leaders expressed frustration at the continual re-organisations of the service; regretted the low esteem in which NHS management is now held; called for greater transparency over safety, quality and clinical outcomes as a way of empowering the public and improving care services; and concluded that the engagement of clinicians, whether consultants, GPs or other professions, is the key to improving the NHS.
Transparency over safety and quality, and clinical engagement, were top of these leaders’ wish lists, and where they saw most hope. But the collective view of the future was far from entirely optimistic Nicholas Timmins, Senior Associate, Nuffield Trust and Editor of the Viewpoint
The interviews are published today by the Nuffield Trust, the independent health think tank, in a new report edited by its Senior Associate Nicholas Timmins, former Public Policy Editor at the Financial Times.
Between them the leaders have more than 200 years’ worth of experience, with their purview spanning the entire NHS landscape of hospitals, general practice, the regulators, and the regional tiers of management that are about to be abolished (primary care trusts and strategic health authorities).
Some are leaving the health service for good, either through retirement or moving on to new roles outside the NHS, and their reflections make for critical reading as the health service prepares for another major re-organisation.
Among the interviewees are:
- Dame Ruth Carnall, soon-to-depart Chief Executive of the London SHA;
- Sir Mike Rawlins, who is about to step down as Chairman of NICE after 14 years;
- Anna Walker, formerly Chief Executive of the Healthcare Commission (predecessor to the Care Quality Commission) and now chair of the Office of Rail Regulation;
- Andy McKeon, who was responsible for the Audit Commission’s work in the NHS and on wider health matters until leaving last year, with the health functions of the Audit Commission having been abolished.
The interviewees told Nicholas Timmins that they needed time: time to build relationships with clinicians; time to develop and implement strategic change; time which often seemed too rare a commodity in the face of constant re-organisation and the strictures of annual planning.
Many spoke bluntly about their fears that recent reforms lacked the transformative potential to make the disruption they caused worthwhile.
The absolute necessity of involving clinicians in management and leadership was repeatedly emphasised. Dame Ruth Carnall said: “if you want to have an influence on outcomes for patients and experience for patients, then what you need around you is the best, most diverse group of clinical leaders that you can possibly muster.”
Some, like former hospital Chief Executive Dr Chris Gordon, highlighted the potential they saw in clinical commissioning groups (CCGs) to create credible and effective clinical strategies. Yet the worry that they might become rebranded PCTs was widespread.
Commenting on the interviews, Nicholas Timmins said: “This is by no means a representative sample. But scattered across these interviews, and at a critical time for the NHS, are many insights and lessons for future chief executives.
“Transparency over safety and quality, and clinical engagement, were top of these leaders’ wish lists, and where they saw most hope. But the collective view of the future was far from entirely optimistic. There was a profound worry about how many organisations and bodies now have to be consulted to achieve any change.
“Bureaucracy, and the extreme politicisation of the service, was bitterly resented. Plenty of the people interviewed suspect that the current round of changes will make this worse, not better. As such, the repeated reorganisations came out as everyone’s top bugbear.”
Finally, general practice was often at the centre of worries around inequality and variation, with Nicholas Timmins describing a “sense that it remained potentially the ‘jewel in the crown’ but one that needs re-setting if it is to sparkle”.
Nuffield Trust Director of Policy Judith Smith, who was formerly herself a senior NHS manager, added: “After the denigration NHS management has faced over the past few years, and in the wake of the Francis Inquiry Report, what strikes home is the feeling that NHS management needs to rediscover itself as a profession.
“But the biggest challenge presented by these interviews is to the NHS Commissioning Board (now NHS England) and the Department of Health which have to persuade ministers to resist the temptation to re-organise the NHS every few years. There is no time for further re-organisation – scarce management talent has to be focused on assuring safe and affordable NHS care."
Notes to editors
- We are also grateful to the Health Service Journal, our media partner for this publication. Further analysis of the interviews from the publication are in the HSJ’s edition of 28 March 2013 – visit the HSJ’s website to read more. The publication itself includes a foreword from Alastair McLellan, editor of the HSJ;
- This publication is the latest in the Nuffield Trust’s Viewpoint series – these provide a platform for UK and international health leaders to explore, discuss and debate critical health care reform issues. This Viewpoint forms part of the Nuffield Trust’s work programme on NHS reform.