We will never modernise our health system until we empower those on the frontline
To flourish post-Brexit we must adopt a new model of public service delivery that prioritises innovation. Nowhere is this more important than in healthcare, writes George Freeman
With Brexit dominating the headlines, tackling the deficit has largely faded from the political debate. But we should make no mistake. The ongoing scale of the structural deficit effectively means there’s a fire in the basement of the British economy. Unless we can find a way to increase productivity in our public services, we face a very real, ongoing crisis in public service funding post-Brexit.
Nowhere more than in health and care. The NHS is facing a perfect storm of productivity and insatiably rising demand, rising cost of technology and treatment and growing patient and clinician frustration with out of date ‘silos’ of funding, making it one of the biggest contributors to the structural deficit. We must act now.
Since the Lansley reforms in 2012, however, there is a general weariness with top down “reforms” from ministers in Whitehall. As most frontline NHS staff will tell you, the real challenge now is how to structure and fund integration with social care, real localization and liberalization from Whitehall controls and targets, to give local leaders more freedom to adapt services to local population need.
So what are the three pillars of this quiet revolution? I believe we must embrace reform around integration, localization and incentivisation.
First, we need bolder integration across the system. For too long there has been a lack of properly joined up planning by different councils and non-governmental organisations. Take one example from my own patch in East Norfolk: we currently have eight Councils, five Clinical Commissioning Groups, NHS England and a separate Mental Health Trust all organising health and care. We will never modernise our healthcare system into a patient and demand-led, preventative, intelligent, responsive, empowering service without fundamental integration.
The Prime Minister’s decision to make Jeremy Hunt the Secretary of State for Health and Social Care is an encouraging first step.
But to truly make a difference and tackle the epidemics of obesity, diabetes, and dementia which threaten to bust the system, it needs to be joined by further localisation. The best people to drive these changes are the NHS clinical and Care sector leaders, local government leader and others who are on the frontline who have first-hand experience of the issues faced by our NHS and care services.
Fundamentally, this is about empowering leaders on the ground. Public sector leadership isn’t easy. Running a major NHS Hospital is equivalent to a FTSE 100 company. Yet we let people with almost no proper management training run them (sometimes very badly), alongside some utterly brilliant but unrecognised leaders. That’s why I’m delighted the Chancellor has adopted my idea of a new Public Sector Leadership Academy to train the leaders of tomorrow.
Third, this quiet revolution must involve changing incentives. The truth is that the current system of financing activity obstructs and disincentives frontline innovation. The brutal reality of ‘command and control’ centralisation of iron budgetary discipline means that if someone delivers ‘more for less’ (as we need our public sector leaders to); we give them less. Year in year out the system punishes productivity and rewards failure. It’s a testament to our heroic NHS staff and a wonder there’s any innovation in the NHS! For too long the politicization of the NHS has held back the debate. The exhaustion with top-down “initiativeitis” means that even if it were possible for one party to do the necessary work to set out a sustainable model, I think the service would reject a one-party solution.
This agenda was at the heart of my mission as Minister for Life Sciences. By properly harnessing the value of the NHS as a research engine, I argued that we could: integrate patient data and become a test-bed for the most innovative treatments around the world, liberate local NHS leaders to innovate and change incentives by securing discounts from the life science industry on new drugs by helping to do the research to discover them.
But to truly realise the potential of these three pillars of 21stC healthcare, we must now go further.
That’s why I support Jeremy Hunt’s calls to take the politics out of the NHS by transferring its management from ministers to NHS professionals (accountable to Ministers and Parliament). Without the proper incentives, local leaders on the ground will never have the room to drive the changes we need.
It’s also why I support the calls for a cross-party commission to look in detail at how the NHS operates and how it could be improved. I believe there are a number of people like the Lib Dems’ Norman Lamb, Labour’s Liz Kendall, several distinguished peers and MPs like myself with career experience in health who could happily and effectively work together to frame a nonpartisan model for a 21st-century health and care system.
The challenge before us is clear. To flourish post-Brexit, we must embrace a new model of public service delivery, putting innovation at the heart of everything we do. Nowhere is that more urgent that in health and care.
George Freeman is Conservative MP for Mid Norfolk and a former Health Minister