Service leaders face a scrap to identify a coherent vision

Has there ever been a time in the past 15 years when health policy has appeared more confused? The Lansley vision of an NHS distanced from political interference is disappearing rapidly as Number 10 confirms that David Cameron is asking for weekly updates on the NHS’s emergency care performance and Jeremy Hunt oversees the service’s winter plans.

‘Simon Stevens’ spring arrival is already being freighted with expectations which would have daunted a freshly freed Nelson Mandela’

NHS England appears to have successfully prevented the Department of Health from turning the annual mandate into a “shopping list”. But there remains significant concern within the organisation that too many government promises effectively constitute an uncosted manifesto for the government’s post-election NHS aspirations.

More broadly, strong themes abound: integration; the need for hospital reconfiguration; improved primary care provision; and increasing the importance of patient experience, to name but a few. Almost all are agreed on the importance of these goals, but there is little consensus on how best to achieve them. Looming over everything is the issue of how much money the service will be given.

Attempts by NHS England and the DH to explore the possibility of accessing more funds for the service are being robustly answered by requests from the Treasury for conclusive proof the service is spending existing funding efficiently.

Relentless reviews

Plenty for health service leaders to conjure with and no shortage of guidance and policy documents flowing from the centre. However, the relentless production of government reviews and responses − on vulnerable elderly people, urgent care, Francis and seven-day working − while worthy in their own right, seem as much to do with creating an impression of a government firefighting on behalf of patients as creating a coherent vision for the service.

‘Nigel Edwards suggested adopting the mindset of contestants on Scrapheap Challenge’

That will probably have to wait for NHS England’s new chief executive Simon Stevens − whose spring arrival is already being freighted with expectations which would have daunted a freshly freed Nelson Mandela.

In the meantime, health service leaders should follow the advice given by former NHS Confederation policy director Nigel Edwards. He suggested adopting the mindset of contestants on Scrapheap Challenge, the television programme that required participants to build complex machines and structures out of random and sometimes broken components. Mr Edwards was writing just over two years ago but his wisdom has never seemed more relevant.