We live in an era of political populism, whether it be “Brexit means Brexit” or “a new kind of politics”.
For healthcare leaders who must guide teams and services through complicated change, populism is a dangerous enemy. It can lead people to believe simple answers are always available and trade-offs are an unnecessary evil.
Explaining that is not the case has never been more difficult, time-consuming, frustrating – and vital.
But populism can be a positive force when applied to something as loved as the NHS. Win the argument and change can be carried through on a wave of popular support.
For those who think this is a nice to do, consider the following scenario.
The election means we now have a generation of engaged activists keen to return to the fray. The NHS was a cause celebre for them and STPs are a target. With the plans moving into delivery mode the campaigns will re-ignite with renewed energy.
One significant weak spot of STPs is a lack of statutory underpinning. The NHS leadership had hoped the legislation promised in the Conservative manifesto would provide some protection. With Jeremy Hunt confirming that will not arrive for at least a couple of years, the door is open to a wave of judicial reviews to sweep over the most contentious of STP proposals.
The UK has become a polarised country and the temptation to exist within a bubble of shared beliefs is ever stronger. The successful NHS leader of the next few years will be the one who can burst that bubble and exposes themselves to difficult to hear and/or counter-intuitive views.
In more stable times the role of the leader was to determine what would happen and plan accordingly. However, history is proving an increasingly unreliable guide and conventional wisdom is turning out to be anything but. The more appropriate response now is to ask yourself: “What would we do if…”, however unlikely.
NHS England chief executive Simon Stevens may have told the NHS Confederation conference the service should have “the quiet confidence we know what we’re doing”, but confidence can quickly disappear if leaders fail to read the changing environment in which they must deliver.
In a world of dogma, flexible thinking shaded with the humility appropriate to this extraordinary age is the most effective choice and offers the best hope to maintaining personal and organisational authenticity.
Facing up to anger
The challenge for the NHS remains best captured in the Five Year Forward View, however much its message may have been obscured by the UK’s political meltdown over the last two years.
Equally, the financial context in which the service operates has not altered for all the talk of softening public sector austerity.
Chancellor Philip Hammond is one of the few Conservative politicians to emerge from the election with his power enhanced.
He remains hawkish on the NHS – and he also lacks the political sensitivity of his predecessor. That does not suggest the service should expect any funding injection over and above that already promised.
In any case, there are more deserving and urgent beneficiaries from any easing of austerity. Reversing education cuts and further bolstering social care spending are two that spring most readily to mind, as does – tragically – the state of the UK’s social housing stock.
Jeremy Hunt has hinted at a relaxation in pay restraint for NHS staff and normally that would be a sign of an imminent change of strategy. But this government is one in which ministers feel free to lobby in public safe in the knowledge a weak PM has no power to remove them – so assuming the pay cap will be lifted soon may be wishful thinking.
Even if the cap goes it is likely to do little to ease workforce tensions. It would take years of above inflation-linked rises to make NHS staff feel they have caught up.
Anger – both among staff and local communities, where often the NHS is the largest employer, is a factor which it is natural to shy away from. NHS leaders must acknowledge and address it if they wish to establish and/or maintain any kind of meaningful engagement.
They must also – without surrendering to empty populism – find a way to offer hope.