The reasons are not hard to find.
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Within a year we will be approaching a General Election in the UK. Along with the cost of living, health is sure to be one of the main topics which will determine the outcome. Nationally, battle lines are already being drawn. The Government is on the defensive.
- Huge performance problems can’t all be blamed on the pandemic and strikes. Ministers have been forced into a rearguard action to address dissatisfaction with access to GPs and are proposing to use pharmacists to alleviate the 8.00 am scramble for appointments;
- The Labour opposition wants to make more doctors salaried and may have to battle the GP's professional bodies who also claim there’s not enough money on the table to make a difference;
- We still have the argument as to whether there will or will not be 40 new hospitals by 2030 – 5 new projects have been added, but the completion of others was postponed. And an admission that some are just partial rebuilds and refurbishments;
- Integrated Care Boards (ICBs) and their Partnerships are still finding their feet and within a year of being set up, are facing swingeing 20-30% cuts in their administration budgets.
The role of local councils
Against this backcloth, top-tier Councils in England are organising themselves after the local elections and realising that health and well-being – including social care – are right there at the top of the agenda. The Conservatives lost control of 56 Councils, and not since 2006 have there been more authorities under ‘no overall control’.
There's the publication of the Patricia Hewitt Review – trying to remove barriers to the holy grail of integration between various parts of the health and care services.
Although it could have been more positive about public and patient involvement, one of its proposals is to strengthen the scrutiny role of local Councils – she wants a system-wide Overview & Scrutiny, and unlike some of her other suggestions, this one might just happen.
NHS five-year plans and future funding
But before this, the existing machinery must confirm the local five-year plans following a process that has been far too stop-start and largely invisible.
Few of the ICBs I have contacted have met the ambitious expectations of the Guidance sent out in December. Many see the 2023 exercise as a dry-run for a more meaningful planning cycle in 2024 where the imminence of the Election will force the NHS to be more specific in the plans it publishes.
Ironically, they may be most controversial where the promised 40 new hospitals are expected. Experience shows that such projects inevitably cause disruption to existing services and facilities with the concomitant consolidation and re-configurations provoking fear and anxiety in local communities.
Then there was a little-noticed but potentially significant line in the Government statement which simply said, ‘Final funding will be subject to future spending reviews.’
Finding opportunity amidst challenges
Readers of the spate of books and articles about Boris Johnson will know that Rishi Sunak’s Government is still struggling with off-the-cuff announcements made with a great flourish but little backing by the former Prime Minister.
Funding the forty hospitals was indeed one of these, so the NHS faces rising expectations in a large number of localities without necessarily the bricks-and-mortar to fulfil the promises that were made.
Fortunately for Health managers, there are, despite the prevailing doom and gloom, substantial amounts of good news for the medium term and beyond.
Crises can bring about creativity and there are tremendous areas of clinical and operational innovations that are becoming possible.
A year ago, Professor Claire Fuller – who is a practising GP – undertook what has become known as the Fuller Stocktake – looking at integrating primary care.
She uncovered and published a wealth of positive changes to working practices that are taking place away from the political point-scoring and her recommendations are quietly being implemented – though slower than everyone might like.
In contrast to the top-down trumpeting of Ministerial munificence in buying new telephony for the 8.00 am rush, Fuller has instead mobilised bottom-up insights and ideas. Describing the Stocktake exercise, she said:
During that time, we have had over 12,000 individual visits to our engagement platform, over 1.5 million Twitter impressions of #FullerStocktake, and close to 1,000 people directly involved through workstreams, roundtables and one-to-one meetings.
The levels of engagement have been unlike anything I have seen for many years – all driven by a collective desire to create the conditions by which primary care can be supported to thrive in the future.
Effective stakeholder engagement for managing health conversations
There is a lesson here for local authorities as well as the NHS.
There are a large number of stakeholder organisations that need to be involved in the inevitable changes that lie ahead, and managing those conversations effectively is no longer something that can be done with emails and post-it notes.
Many of these bodies include community leaders occupying multiple roles. In some, they will be critical and look for improvements and remediation. Wearing other hats, they may be anxious to help, keen to promote volunteering and able to facilitate the growth of preventative healthcare or social prescribing.
In England, we have new structures whose job is to harness this goodwill whilst managing the concerns and disappointments. In Wales, Scotland and Northern Ireland, similar pressures apply even if the politics are different.
Everywhere, the task is to manage the dialogue between public health and care providers and their communities. What’s needed is proper investment in public engagement skills and the systems to make their efforts work well.
Written by Rhion Jones
Rhion Jones was the Founder Director of the Consultation Institute and is an acknowledged authority on all aspects of public and stakeholder engagement and consultation. He advises Tractivity and will be contributing expert analysis and commentaries on current issues.
Rhion now publishes thought leadership articles regularly as the ConsultationGuru.