‘The message from last Thursday was that we need hope, not fear – and we need a Queen’s speech about hope, not fear’.
Those could easily be the words of Jeremy Corbyn, a Labour party voter or a union leader like Len McCluskey.
But those were actually the words of Chris Ham, chief executive of respected health think tank the King’s Fund – speaking at the NHS Confed 17 conference on Wednesday.
During a debate over what the first 100 days of the new Government should bring for the NHS, Professor Ham was clear that Government policy must change in the face of an NHS struggling to cope and an electorate which has refused to sanction a strengthened mandate.
‘There’s no mandate for a hard Brexit and we now need one that will help and support the NHS around workforce particularly,’ Professor Ham said, ‘The voters also said we’ve had enough of austerity and cuts in public spending.’
So where should the Government look to make changes in policy and attitude?
During the debate, in which Professor Ham was joined by Nigel Edwards from the Nuffield Trust, Jennifer Dixon from the Health Foundation, Amanda Doyle from NHS Commissioners and Julian Hartley, chair of Leeds teaching hospitals, the answers were more or less unanimous.
Politicians should, according to the panel, back Simon Stevens’ Five Year Forward View – and give it the resource needed to make genuine improvements, particularly in integrating services, general practice, mental health and preventative health; produce a more generous funding settlement for the NHS; guarantee the role of EU staff working in the NHS and address workforce concerns more widely and hold a full review of social care and invest in digital infrastructure.
For Mr Edwards workforce is the key issue.
‘The one that worries me most is the workforce – it appears the whole workforce planning system is significantly broken and I don’t see any major attempt to fix it,’ he said.
‘It’s at least a big a problem as the money. We need to guarantee the position of current EU nationals and also need to change the rhetoric more generally about whether we welcome migrants. There’s a slightly nasty rhetoric strand – sometimes from the Prime Minister – and we need to change that.’
Like the BMA has argued for many months, Mr Hartley suggested urgent investment was a significant priority – suggesting the state of infrastructure, due to lack of funding, was parlous.
He said: ‘It’s clear we need investment and I would hope that the outcome of the election means the Government and Treasury are rethinking their plans for the NHS. I’m thinking specifically about capital – hospitals are struggling day in day out with creaking infrastructure. We saw that with the cyber-attack and the level of backlog maintenance bills are rising. Those are the key priorities for us.’
He added: ‘We need a bigger response than the amount of capital announced some months ago for STPs [around £325 million] – we could use that in West Yorkshire alone never mind across the country. If we are going to accelerate and reinvigorate the changes as part of FYFV and STPs none of that can happen without investment.’
NHS plans for transformation rely on devolving power – and budgetary responsibilities – to local areas and getting rid of the purchaser-provider split which has grown into a heaving bureaucracy in recent years.
And for Ms Doyle progress on legislation, governance and structures to allow this transformation – alongside more cold, hard cash – is key.
She said: ‘We need the system to change – it’s not working entirely as it is. The commissioning system needs to develop, we just need to not lose the clinical leadership and clinical input to the decision making and involvement that we’ve had. We do need cash but we have to be clear that we need to ring fence that for transformation – giving us cash which soaks up deficits isn’t going to let us make the change we need to make.’
She added: ‘We need something that allows us to progress accountable care, get rid of some of those barriers to intervention and get rid of some of those barriers around tariffs and the market.
‘At the moment because of the current set-up we’re having to do a new world and carry on doing the old stuff as well – but we need to let ourselves move on.’
Not all the problems facing the NHS can be solved by money, political will, legislation or more doctors on the frontline though, according to Mr Hartley. The NHS, like the rest of society, he said, is facing down the difficulties of a divided society – and that needs to change.
‘From a hospital provider perspective we are in a challenging and uncertain time in British society in terms of everything that’s going on at the moment – if there on things, what Governments can do is set the tone, create a sense of community cohesion and support us to do that across our communities.
‘Last Thursday in Leeds we had a bomb scare, we had to evacuate the hospital and had patients in the car park. I had members of staff coming to me and saying they were worried about where we were going as a country. There’s a large number of people in the country who want an agenda that’s about coming together as a community and the NHS can play a part in that.’
As Professor Ham said whatever comes over the next 100 days society, and the NHS, needs hope, not fear.