If there’s one issue that will be the touchstone for success during 2010 it has to be trust.


When we look back to 2009 so many issues have had trust at their heart. Government, banks and economic management, the war that was Iraq and the war that is Afghanistan, and the future of public services funding are just a few disparate examples linked by the common theme of trust.


Little if any change can achieved successfully without trust being in place first. The trouble is it takes time to build up but only a poor decision or inappropriate remark to throw it all away. Remember Gerald Ratner?


For the NHS to successfully navigate the challenges of the next few years will require, first and foremost, trust. Trust that the new government (of whatever hue) fully understands the real implications of the recession for public services, trust in senior NHS management that they will be supported and defended politically and managerially when tough choices have to made, and that reciprocity of trust is maintained with clinical staff and the trades unions when the going gets tough.


Of course we trust people on the basis of what they do, not on the basis of what they say they’re going to do. Trust is one of the few solely action-based concepts in management. The ongoing debate about the control of bonuses for bank employees and the Mexican standoff that has occurred between banks and government is a good example here. Whilst the recent accusation from the President of the Girls’ School Association that schools are subjected to an ‘initiative a week without the sense of a coherent plan’ (reminiscent of the NHS a decade ago I think) will further test teacher and parent trust in government.


Yet for the NHS there is much to be positive about. The FT movement has considerably sharpened the quality of NHS management, WCC is driving up commissioning capability albeit more slowly, and the NHS overall has a more solid foundation of sustained delivery and service quality than at the time of the last recession. A good place for starting to build trust perhaps?