Tough times ahead with reforms in healthcare
Tough times ahead with reforms in healthcare
The Health and Care Bill is about to make the job of NHS leaders a lot more complicated. Engagement with the Integrated Care System (ICS), local MPs and ministers will greatly add to the complexity and political sensitivity of running local health services.
Political skills have always been an important part of a chief executive’s role. Apart from the internal politics of the NHS, any good chief executive dedicates time and effort to maintaining constructive relationships with local government members and officers and local MPs. Used skillfully, these relationships can help trust boards understand local opinion and concerns as they consider service changes.
But the bill now before Parliament takes the involvement of politics in decisions around local services to a whole new level. Ministers will have to be informed about every service change – even temporary ones – and the Secretary of State will be able to call any plan in and overrule it. This in turn will increase the clout of local MPs and councillors – particularly from the ruling party, of course – as they can set the local mood music.
Alongside this, the role and function of the ICS is far from clear, leaving much to be determined by local culture. In its response to guidance from NHS England on how they will operate, NHS Providers got to the heart of the matter, highlighting the potential for conflict over whether the ICS is the sum of its parts or a separate body managing the local health system.
Inevitably it will be both, but chief executives have difficult decisions to make about whether their time at an ICS meeting is spent negotiating on behalf of their institution or being there for the greater good of the health system, even at the expense of their own organisation’s position.
Since chief executives are and answerable to their board, NHS England and the Care Quality Commission for that organisation’s performance, ultimately the priorities of the broader health system are likely to take a backseat – but that reality conflicts with the spirit behind the integrated care reforms.
“Chief executives will have a tough time managing the interests of both the ICS and their institution.”
So chief executives will have a tough time managing the interests of both the ICS and their institution, while the spectre of being overruled by ministers will require fine judgements about when operational necessity should be hedged in the interests of political expediency.
So how should chief executives handle their relations with local MPs and councillors? Open and early engagement is key, so they feel that they can influence the discussion rather than simply be asked to rubberstamp a decision. Listen to and consider their concerns. Present them with robust evidence, and get them in a room with senior medical staff. Avoid the perception that you are politically partial or aligning with a particular local party to win your case.
Clinical data, however compelling, is no guarantee of success. Trying to force a decision through because you are convinced of the righteousness of your cause is unlikely to end well. Present your analysis through the prism of the interests of local people rather than just the efficiency and effectiveness of the healthcare system. Pick your battles carefully.
“I am repeatedly impressed by the resilience of chief executives and other leaders in the face of immense pressures, and their ability to keep moving forward despite extraordinary headwinds. ”
If you present your case to civil servants, position your arguments in ways that will appeal to ministers. Read the speeches of health and social care secretary Sajid Javid to understand what matters to him. Talk to colleagues in the NHS, civil service and local government about how to pitch your case. Keep it short and clear.
The ever-lengthening list of attributes required of a successful NHS leader explains why even the most talented and experienced can stumble. I am repeatedly impressed by the resilience of chief executives and other leaders in the face of immense pressures, and their ability to keep moving forward despite extraordinary headwinds. These are exceptional jobs for exceptional people.
Through our dedicated team in our global healthcare practice we work with executives on these issues almost daily. Do get in touch if we can help advise or lend a perspective on the challenges you face in your organisation today.
Global Managing Director, Healthcare & Academia
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