The introduction of NHS ‘league tables’ was the headline for most mainstream media news following the speech by the Secretary of State for Health and Social Care at the NHS Providers conference yesterday (November 13). However, there was a lot more to the detail than that, including a programme to invest in leaders – including non-clinical, to give them the skills they need to drive change and deliver excellence in patient care and service.
“Reform needs to do a lot more heavy lifting,” Wes Streeting told NHS leaders present, before going on to set out a broad canvas of his ambitions for that reform. “I want to lead an NHS where power is moved from the centre to the local and from the local to the citizen,” he said. This means from the centre to Integrated Care Boards (ICBs), from there to providers and from there to patients.
Two fundamental facets to this plan are more clarity, and a smaller centre. The centre, he said, should decide strategy, policy and clear objectives, allocate resources against those objectives and provide the accountability framework for improving performance. Then, as “power” shifts from the centre, resources should follow it.
“We need more doers and fewer checkers, and the centre needs to learn the words ‘stop’ and ‘or’ after years of ‘start’ and ‘more’.
“Clear priorities mean a few, not 50 different targets. So, the instructions coming out in the forthcoming NHS mandate and following planning guidance will be short. I want to see waiting times cut, urgent and emergency care when people need it and improved access to primary care. The shift from hospital to community needs to start now.
“Amanda [Pritchard] set out yesterday that NHS England, not ICBs, will be responsible for managing performance of Trusts. When I talk to ICB leaders I hear mixed views about where they should be focusing their efforts. There is no uniformity and too much confusion.
“So let me be clear: I want to see local commissioning back and I want to see ICBs leading it.
“ICB chiefs, I am talking directly to you: you will lead the transformation of care – the pioneers of reform. Your organisations will play a critical role in doing what we’ve never pulled off before.
“I want ICBs to focus on their job as strategic commissioners and be responsible for one big thing: the development of a new neighbourhood health service. It will focus on building up community and primary care services with the explicit aim of keeping patients healthy and out of hospital, with care closer to home and in the home.”
ICBs are being tasked with ensuring that “fragmentation” gives way to “integration.”
Assessing performance
The Health Secretary pledged that the best-performing ICBs would enjoy greater freedom and flexibility as he set out what is being dubbed a new ‘league tables’ system.
“We’ll assess systems against a set of criteria and publish the results, starting from next year. Those systems and providers that are in the middle of the pack will get support to improve to bring them to where the best are now.
“Those ICBs and providers that are doing well will be rewarded with greater freedoms over how to spend their capital, with fewer ring fences for example.
“Those that demonstrate the best financial management will get a greater share of capital allocation. We want to move to a system where freedom is the norm and central grip is the exception to challenge poor performance.
“So, improving services for patients should be rewarded. The quid pro quo is that there will be no more rewards for failure.”
In plain terms, this means Wes Streeting will “reserve the right to take those freedoms away” if performance dips. Whilst for those organisations judged to be persistently failing: “We will go from zero consequences for failure, to zero tolerance.”
This hard line extends to leaders – those in charge of organisations that persistently fail to provide “decent” care, or control their finances, will not receive annual pay uplifts. Likewise, failing ICBs, Trusts and Foundation Trusts will have the access to capital flexibility referenced above, removed. Turnaround teams will be sent in to failing organisations to diagnose and help to fix problems – and if leadership is found to be lacking, “they will be removed,” the Health Secretary promised.
Upskilling clinical and non-clinical managers
This is not just singling out managers for blame, Wes Streeting insisted. Instead, he said there would be: “no more manager bashing for manager bashing’s sake.” One of the conclusions of Lord Darzi’s investigation was that the NHS does not suffer with too many managers, but rather not enough with the right skills and capabilities. Hence, he announced plans to “invest” in and “support” managers – both clinical and non-clinical.
These plans include a new management and leadership framework for the NHS, with a single code of practice, set of competencies and a national curriculum to help develop essential leadership capabilities.
The Health Secretary also announced that a college of executive and clinical leadership would be established, which would help to train and develop excellent NHS leaders. “Non-clinical leaders should be working in lockstep with clinical leaders and that’s why I want this resource to be available to every type of leader in our NHS,” he said.
