What is it about your job that you feel would surprise the public?
The sheer variety of what is involved. No day is the same and can cover everything from big strategic decisions about services to matters of very fine detail that impact on the lives of individuals. I think most people would also be surprised by the complexity of the health and care system!
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
Things are fundamentally different from how they were in 1990. Back then people waited years for treatment, there was no system of clinical governance or quality guidelines at a national level and the estate was crumbling. The focus was also very much on episodic care rather than long-term condition management, frailty and joining up services, and outcomes for big killers like cancer, cardiac and vascular disease were much worse. Things are much better today.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
To really make the NHS and care system a great place to work. We need to get people to work in it and recognise the huge number of opportunities available across a broad range of careers. They need to feel able to drive and own the changes that we need to make, by working together and with families, carers and services users.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
Devolving as much power as possible to the front line is the only way to deliver the modern health and care system.
What do you wish people at the top of the NHS understood?
That the NHS is made of people, not structures. The role of those at the top is to facilitate and create the conditions for staff to succeed by creating good collaboration at all levels of the system, from Whitehall to the town hall. When we do this magic happens, because we have some of the best and most committed people in the country.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
The drive to reduce waiting times in the NHS in the late 1990s and 2000s. It worked because of the right alignment of political leadership, planning, incentives, investment, performance and regulation. It genuinely transformed care and the experience of people across the country.
What policy have you seen fail, or not be as successful as first intended?
Improving access to general practice. We used to have a genuine improvement methodology for improving access, which was only partially implemented. A performance approach was subsequently used and led to the “call at 8am” system many people endure today.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
The move to an integrated care system in West Yorkshire and Harrogate. I think it’s going very well because we have spent time on the relationships between leaders in councils, the NHS and our communities. Alongside this we’ve got good governance and we’re working on big issues like mental health, urgent care, cancer, loneliness and supporting carers. Our success is obvious in the visible improvements we are making to care and in the sense of collective leadership that we’ve created.
The NHS is under pressure because...
It needs a coherent plan across a broader health and care system, with enough staff and money to implement it. We’re on our way to delivering this but aren’t there yet.
Rob Webster is the Chief Executive of South West Yorkshire Partnership NHS Foundation Trust.