A recent seminar with a group of non-executive directors to discuss dysfunctional boards and corporate failure demonstrated how grounded they are about future challenges facing the NHS and their organisations.
No-one believed that the NHS was financially sustainable without some form of restructuring. The idea that the NHS could remain as it is in light of current financial and future service pressures is plainly ridiculous. The only question worth debating is what form any restructuring would take. The other view discussed, which is always raised as a general election approaches, is whether the new government would take any necessary radical action in its first year? Unfortunately, history shows this is unlikely, a view seemingly supported by the policies as currently outlined by the two main parties. None are especially radical but there again why would any poltical party give away their detailed plans at this stage? And recent ideas and proposals such as greater integration with social care and an arms-length management board are appropriate but not new.
I would suggest that until the core issue of the structural link between a mixed hierarchical and regulated service is addressed, exploring other structural variables will produce only limited options. This is a crucial time in the history of the NHS given what has been achieved in recent years. Sustaining these achievements (access, improved quality, better financial stability, etc) will take enormous effort in the coming years. They risk being blown off-course because of uncertainty of political leadership in the first year of the new government.
What would be radical for a new government would be to engage with managers and other leaders about what is required to maintain sustained performance and deliver the next phase of the NHS. Yes, whatever emerges from these discussion will need to be tempered by political considerations but given that history shows it’s the management community that leads the delivery of government-driven change, a short time spent on being genuinely consultative could produce longer term dividends. Again, not a new idea but one that’s never really been tested.