Barring an act of god, the Health Bill will receive royal assent in the next few weeks. Its passage has been a bruising experience for all involved and the fierce, polarised battle it inspired will leave a legacy of bitterness in many.
Speaking at the Nuffield Trust policy summit last month, health secretary Andrew Lansley said that as the reforms took effect, NHS staff would realise the worst predictions made about the changes were bogus.
This claim is another example of the health secretary’s ability to let wishful thinking trump reality. NHS staff have heard little but bad things about the reforms from professional organisations and the media. They may not hold either in high regard, especially the latter, but all evidence suggests they have even less time for government reassurances.
This point was effectively admitted by Mr Lansley when he told the summit: “I’m not here to restore faith in politicians.” This is a statement you cannot imagine any other cabinet minister making, including the health secretary when he first swept into Richmond House promising to end top-down control of the service, tearing up targets to show he was serious.
At the worst, staff are suspicious of the reforms and uncooperative in their implementation. Even at the best, many will be disengaged.
Lack of engagement is death to healthcare reform. It has put paid, eventually, to every NHS reform for decades. Orders from the centre and an army of enthusiasts will only take you so far. Even the New Labour reforms of the last decade, turbocharged by billions of pounds of extra funding, eventually ran out of steam because too few staff understood and/or bought into the thrust of many of the changes.
To achieve deep, long lasting change in the NHS, you need a sense of shared endeavour and purpose.
This is where HSJ readers, as the clinical and managerial leaders of the system at national and local level, have a crucial role to play.
It is the role of leaders to find the good in these reforms – and there is enough to work with – and interpret them for the specific challenges facing their teams. Equally, they must learn how to manage any negative consequences in a way which mitigates their impact and soothes the bad feeling. Many have been doing just that for well over a year.
Our feature on the seven habits of successful medical leaders places “bravery and resilience” at number one. It is an appropriate ranking – for healthcare leaders of all types – especially at this time.
It will be all too easy to blame difficult decisions on politicians and mandarins, to say to cynical staff, “I agree with you, but what can I do?” It will be just as easy to barricade the boardroom or office and make plans away from the concerns of those outside.
The temptation to do either may often be overwhelming when one considers the storms ahead. Some, like the tensions created by pension reform, are out of the control of the great majority, but still have to be handled locally.
Pay seems set to become an issue which will be returned to the local in-tray and the scale of the problem is revealed in HSJ’s exclusive analysis of trust pay levels. Then there is the role of the private sector – from which an increasing number of leaders will come. Determining and striking deals which will benefit NHS patients will test the skills and courage of many.
It is little wonder that it is the third habit of leadership which may yet prove the most important. Few will succeed in such a testing environment without a healthy dose of optimism.