Don't just 'hope' for change

Matthew Taylor argues change in the healthcare system needs to come from the bottom up as well as top down, regardless of who wins the next General Election.

Between now and the General Election, scarcely a day will go by without one advocacy organisation or another publishing its manifesto. To give The MJ's readers a sneak preview of the NHS Confederation's own plan, you can expect a call to avoid reorganisation and to focus on capital investment and workforce (including social care). The Health Foundation's recently published five-point plan for a new government features extra investment, a greater focus on population health, accelerating innovation and reforming social care.

It is to be expected and welcomed that there is a convergence between the manifestos emerging from a variety of health research and advocacy bodies. We can only hope that the major parties echo this analysis when they publish their final offer to the country.

But any credible wish list comes with a recognition that an incoming government will inherit a challenging context. A new secretary of state for health and social care will find it hard to persuade a chancellor defending fragile public finances and seeking market credibility to hand over significantly more investment. Given what the Office for Budget Responsibility has referred to as ‘fictional' public spending plans, the case for health will also have to compete with other sectors and services, from defence to criminal justice, each with a compelling argument for more money.

Indeed, speaking to the health leaders we represent I often hear a recognition that the NHS' funding challenges, however hard, are ultimately more manageable than those facing local government colleagues. One of the advantages of system and place working is a greater appreciation of interdependency between health and local government.

While there is an ongoing need to make the case for help from government, the NHS Confederation is working more with our leaders to explore how we ourselves would go about achieving a financially sustainable health service with improving outcomes. In other words, we want the question not to be ‘how can a new government save us?' but instead ‘how can we continue to improve the health service and how could a new government support us in doing so?'

From fast-tracking necessary service reconfiguration, to reducing the weight of regulation, to managing public expectations, there are many resource-neutral things a government could do to create a more enabling context for local leaders to improve efficiency and outcomes.

By comparison to Labour's victory in 1997, our next government will be elected with modest public expectations. But this may be a good thing. It should force those lobbying politicians to think harder about their responsibility and that of other civic partners to widen the space for change.

To take one example, a new administration may have a more explicit commitment to a whole government approach to health improvement. The NHS Confederation would welcome this; indeed, it will be contained within our own manifesto, but we shouldn't simply sit back and hope.

More concretely, change needs to be driven bottom up as well as top down. That's why we are delighted that the Department for Health and Social Care has now agreed to work with us and the Local Government Association to implement one of the key recommendations of last year's Hewitt Review. This is the establishment of a forum of Integrated Care Partnership and Integrated Care Board chairs with a mandate to engage ministers and officials across Whitehall.

Several years ago, I was asked by the then-opposition leader to suggest some lines for his party conference speech. I suggested the following: ‘When we think about the election, we often talk about winning power. In reality, all we win is the opportunity to create power by working in partnership with civic society and communities on a shared mission of change.'

Whether an incoming government makes a difference may depend more on the preparedness and willingness of those of us outside Whitehall to embrace challenge and change than it will on the skills of a new cabinet.

Matthew Taylor is a public policy expert, former adviser to Tony Blair while Prime Minister and currently chief executive of the NHS Confederation

X – @ConfedMatthew


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