Few doubt that NHS chief executive Mr Stevens played a masterstroke with the NHS Five Year Forward View. He has enjoyed an extended honeymoon at the helm of NHS England since taking up the post in April.
Those who work in the NHS and those that depend on it were waiting for the newly appointed prince from across the ocean to set out his vision for the health service.
‘Jeremy Hunt has found that he no longer has the power to make the NHS skip to his beat’
Having rallied other national NHS organisations to his banner and publishing shortly after party conference season, the forward view was designed to seize the initiative.
With its compelling vision of service change and a renewed focus on prevention, it came as no surprise to see left and right trip over themselves to sign up to the new gospel.
Much in the vein of his former boss, Mr Stevens has seized the “centre ground” of health policy. While policy watchers now wait for the parties to bring forward their manifestos, few expect that any major party will in any way digress from his vision.
Core principle
In many ways the forward view was the culmination of a process started by Andrew Lansley and his white paper Equity and Excellence.
Taking politicians out of day to day management of the NHS was one of the core principles of this parliament’s reforms.
Whatever the rights and wrongs of the reorganisation of the NHS, it succeeded in moving many of the levers that were previously at the health secretary’s fingertips out of the Department of Health and into NHS England, Monitor and the Care Quality Commission.
Despite his zeal to take control Jeremy Hunt has found that he no longer has the power to make the NHS skip to his beat.
NHS leaders have clearly been emboldened in the new architecture.
In recent months a grand pact has been offered to politicians: “Give us the tools, get out of the way and we will finish the job.”
As well as official policymakers working through the forward view, providers, professions and user groups have come together under the “2015 Challenge” manifesto to set out what they want from politicians.
‘There’s a strong case for keeping politicians out of day to day management of tricky service changes’
Their shared “asks” from politicians include a stable policy environment, national backing on the case for service change, a transition fund and honesty with the public on future funding of health and care.
On many levels relegating ministers to simply raising revenue and giving political cover for NHS managers to push on with unpopular changes to local services does indeed sound attractive.
Certainly the recent National Audit Office report on the better care fund makes a strong case for keeping politicians out of day to day management of tricky service change projects.
Constant change
Many have pointed out that while the NHS needs a 10 year strategy, the average tenure for a health secretary is two years.
Constant chop and change at the top frustrates painstaking reform on the ground. But while the Five Year Forward View may appear to be the triumph of “depoliticisation”, the problem of what to do with ministers and the DH has now veered into view.
Despite calls for a 10 year funding commitment, it is unlikely any future government will look favourably on giving the NHS a blank cheque. Opening the Treasury’s coffers will come with strings attached.
Indeed, all three party leaders have proposed new targets in recent months, whether to improve access for mental healthcare services, GPs at weekends or cancer diagnostics. But will a new wave of targets help or hinder the service change described in the forward view?
‘NHS England will need to find ways to make the department feel big and important. There is still expertise in Whitehall that can be put to good use’
Just like with the better care fund, ministers, for better or worse, want to make announcements, introduce bold reforms and make a contribution.
And now that NHS England and Monitor are doing the heavy lifting, ministers have had to entertain themselves with pet projects such as the “pioneers programme”, the better care fund or indeed managing an accident and emergency crisis from a bunker in Richmond House.
While well intentioned, these may potentially detract from the bigger goals of health reform.
While Mr Stevens has stolen the initiative from any future health secretary, NHS England will need to find ways to make the department feel big and important. There is still expertise in Whitehall that can be put to good use.
Of the few areas of policy that still sit within the department, two are crying out for ministerial attention:
- one could be a review of national terms and conditions, like the ones implemented at the Home Office, in recognition that new models of care will require a more flexible workforce; and
- second, ministers could take a look at what are the optimal performance and patient outcome metrics that would help Simon Steven’s achieve his vision.
Either way, the NHS needs to find a way for politicians to pull their weight without just bringing the money to the table. Otherwise they will keep getting in the way.
This blog originally appeared on the Health Service Journal website