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'Dear Jeremy, no new initiatives, please'

Jeremy - congratulations and welcome to your new job. I gather that your brief is to focus on implementation and to keep health out of the news. That would be great.

The NHS needs no further reorganisations, and new initiatives would distract an already beleaguered workforce. David Nicholson can do a lot of the heavy lifting for you.

You inherit an NHS that is very good by most international standards and delivers great care much of the time. It is easy to overlook that in all the fuss there has been about health reform. Please look after the NHS and remember that people genuinely value the “N” part.

As you will know the service is under great pressure. The current funding freeze is without precedent. And demand is growing as the population with chronic conditions and disabilities rises. The most serious problem is on the social care side. For want of domestic carers, befrienders and handrails, we are admitting too many people into hospital for too long and at great expense, while making them more ill. This can’t go on and you will need all your powers of persuasion to get David Cameron and George Osborne to agree who pays for what. Norman Lamb will be a great asset as you see this through.

Before long the Francis inquiry report will hit your desk. The factors that contributed to failures of care in Stafford are still to be found in the NHS: inadequate leadership; confused accountabilities; multiple regulators; and above all, staff not listening and responding to patients and families. One thing is for sure: the answer is not more regulation and I hope you will resist any calls for gold plating the regulatory system.

You predecessor created a lot of complexity which you will have to get your head around. By contrast the white paper Equity and Excellence contains some strong and simple themes: patients at the heart of the NHS; clinicians taking more control; a great focus on outcomes. These are good ideas and need to be seen through.

“No decision about me without me” was a great slogan but we were never quite clear what your predecessor meant by it. Giving people more choice is certainly part of it, but while patients value choice, there are things they value more: good information; participation in treatment decisions; support; compassion; joined up care; being listened to. This is the stuff of the NHS constitution and you will shortly receive advice on how the constitution can be strengthened. For the NHS to perform as described in the constitution would be a fantastic legacy for you to leave.

You are new to health. That is great. It will help you stay strategic and focus on the interests of those who depend on health and social care. I understand that you and your new team will be expected to communicate the government’s agenda more successfully. Please remember that communication is a two-way street and that there is also a need to listen. There is much wisdom in the service to draw on; and those of us in patient and voluntary organisations can give you a lot of help.

Good luck!

Yours sincerely,

Jeremy Taylor, chief executive, National Voices

Readers' comments (2)

  • Well said.

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  • Totally agree. One good thing about the reforms is that they have provided an opportunity to have lots of discussions across the whole sector on what "integration" means, on what "choice" means, on what "information" means, and what genuine patient empowerment looks like. We know what works. We know what good looks like. Now is the time to make it happen.

    But to do this, we must divest the reforms of ideological flavour and genuinely bring it all back to the patient.

    It is also important to take a long-term, big picture view of health needs, and tackle problems at source. Local populations are not distinct, homogenous entities, and we must not let localism blind us to the shared needs which cut across local and regional boundaries. An ageing population with an increasing number of co-morbidities requires a genuinely patient-centred approach focused on self-care, shared decision-making, care planning, prevention and challenging health inequalities - and getting the right care to the right people, at the right time. That is not going to be achieved by simply pushing all the difficult decisions down to bodies and individuals who may or may not be adequately equipped, or desiring, to take them.

    Organisations like National Voices and ARMA can provide a wealth of expertise, as well a direct line to the patient voice. We can and want to help. But as Jeremy said, communication is a two-way street.

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