With the challenge ahead my initial thought was that I don't envy Wes Streeting, but on reflection, maybe I do. Along with many others I was working in the NHS in the late 1990s when Labour last had the opportunity to set out a 10-year approach to revitalising the NHS. It was hard work and not everything worked, or at least not quite how it was planned, but it really did work. We saw dramatic reductions in waiting times, new staff roles to work with emerging technology, supported evidence-based interventions to improve outcomes and a focus on quality and examining processes to get the most out of the resources available.
However, Wes Streeting can't just dust off the old plan and run it again.
The main reason being that the context has changed in many ways:
The appetite isn't there from the Treasury to fund the dual running and cost of change this time
- Staff are exhausted after the pandemic and the work to recover from it
- The service has suffered from chronic staffing shortages
- The built environment needs more work than ever before
- The complexity of supporting a post-pandemic population has yet to be fully understood
However, there is a blueprint for success there in the previous plan:
Trust that the underlying problem is lack of capacity and support, not lack of integrity and capability
- Put in place the support needed to make sustainable change
- Give staff breathing space
- Recognise that you can't just demand improvement and cost savings within a year
The NHS took many years to get to this state, and it will take time to heal.
What I want to hear from the new Health and Social Care Secretary is a combination of compassion, pragmatism, determination and optimism. But more than anything I want to hear that he will find a way to invest in social care and do more than pay lip service to prevention. We need to invest in the future wellbeing of our population as well as their current needs.
More than this, investing in social care now will address the current shortfall in supporting the most basic of needs which provide the bedrock of a thriving society. The virtuous cycle which builds from this can rapidly reduce the ask of urgent and emergency care (including GPs) coming from those in distress with nowhere else to turn. The strain on families and carers which impacts their health and wellbeing will also reduce as a result. If Wes Streeting can address this he can avoid building and scaling an NHS to meet needs which are currently there but could be avoided altogether.
Whilst he is at it, if he can work with his colleagues in housing, work and pensions and communities and influence them to prioritise wellbeing in their plans we could see a seismic shift faster than you think.
I am also hoping that the renewed interest in devolution will see the revitalisation of the rail network in the North of England handed over to the elected Mayors. Andy Burnham and Tracy Brabin could crack the Trans Pennine/Northern rail challenge together. This would support a meaningful investment in the Northern Powerhouse and the associated economic benefits for the region - and deliver a knock-on impact on the health of the population (see what I did there).
It's time to allow the good people out there to do what they do best. The micro-management from the top approach creates the illusion of grip, but in reality, is just a speed limiter. True assurance is built through good governance, not excessive scrutiny.
The NHS rightly remains a cornerstone of how we think about ourselves in the UK. With the right approach I believe it can live up to its potential to support a healthier and fairer society for all. I am not prepared to lean into the narrative that the NHS is broken. The concept and aim of the NHS is intact and whilst it has been damaged it is certainly not beyond repair with some optimism and TLC.
The key thing is, I think a lot of us want to be part of making this happen - all Wes Streeting needs to do is let us.
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