By the time you read this we will have launched The NHS Alliance with our new brand and membership offer. Our members told us they wanted the NHS Confederation and NHS Providers to come together, combine our strengths to bolster our collective voice and minimise our costs. That is exactly what we are doing.
I have mixed views about my own time at the helm. There are some things of which I am unambiguously proud. For example, I recently attended another inspiring gathering of the national health and work network we host jointly with the DHSC with support from DWP. It can sometimes feel the idea of a cross-government health mission and a wider view of health and society have fallen far down the agenda, but the 200 or so local leaders at the event are determined to build a new economic case for the NHS by showing how we can contribute to employability and inclusion.
I will really miss this job, the team I have worked with and our members, who have so kindly shared their time, experience and insight. But I also feel some relief: leading The NHS Alliance is going to be a tough gig.
When last year we consulted members about the new organisation they emphasised our role in speaking truth to power; after all, as Healthcare Management shows, there is a big and substantive gap between Panglossian DHSC press releases and the withering contempt of recent HSJ editorials.
Being honest in the NHS can be career threatening and it's our job to expose inconvenient truths. Like, for example, the widespread fear in trusts that meeting next year's financial targets will be much harder even than it has been this year and will involve inevitable trade-offs on activity, quality and safety. But we aren't under any illusions: saying difficult things will rarely be welcomed by those in power.
Yet getting our public stance right is not the hardest part. The greatest strength of The NHS Alliance is also its greatest vulnerability: we represent all parts of the service.
From Ken Clarke to Wes Streeting, almost all major NHS reorganisation over the last forty years can be seen as attempts to address the founding flaws of a service that is too centralised nationally and too fragmented locally. The tragedy is that policy makers fail to learn from history how hard this is to do. So, they continually reform in a muddled and half-hearted way, hoping this time will magically be different. An essential step change in patient-focused collaboration requires much greater courage and clarity at the centre and much greater buy in from the service on the ground.
London based officials not only tend to underestimate the difficulty of local collaboration, but their centralising assumptions can make working together more difficult. At one of our recent gatherings of acute leaders just about everyone said the disincentives to working with local partners had grown over the recent period. A national NHSE leader described to me areas where ICBs were trying to commission service pathways to move money out of acutes into community and primary but went on to say that a predictable consequence has been local trusts complaining to the centre that this makes it impossible for them to meet financial targets. History, again, tells us who tends to win that battle.
At the heart of The NHS Alliance's governance will be a policy committee comprising the chairs and deputy chairs of all our member networks (acute and ambulance, community, mental health, primary and commissioners). It is vital to the credibility of The NHS Alliance and the future of the NHS that this is an honest, robust, creative and evidence-led forum. If service leaders can't work out difficult issues between them, they can hardly complain when the centre reverts to infantilising.
But if we do have tough conversations and if that does mean different interests have to compromise for the good of patients and the service there will always be siren voices arguing for a more self-interested approach. This, sometimes actively encouraged by the centre, has been part of what has broken up previous iterations of an all-service NHS membership organisation.
Having spent nearly five years working with the NHS, I have no doubt the leaders of the service have the skills, values, commitment and imagination to achieve a step change in patient care and put the NHS on a sustainable footing. Bringing the whole service together in The NHS Alliance is a huge and urgent opportunity, but there is phrase we must metaphorically nail over our doorway: ‘United we stand, divided we fall'.
