One thing is for sure, the NHS will 'muddle through' – it always does. So, no, there won’t be a major crisis that will bring it to its knees, neither will there be a panacea on offer that will cure it of its ills. That said, the nature of the ‘muddling through’ will, I suspect, be different in 2012 from how it has been in the recent past. I suggest four reasons for this.
Firstly, commissioning will remain a muddle. It is anybody’s guess which model of commissioning we will end up with. Will clinical commissioning groups be where it is at, given full authority to determine the needs of their communities, empowered to take tough priority setting decisions and assuring the quality of care they commission? Or will power and authority slip inexorably upwards to the local outposts of the NHS Commissioning Board? I would wish for the former but I fear the latter, as for decades Ministers have used the rhetoric of shifting the balance of power closer to patients while allowing officialdom to ensure the reverse.
Secondly, patient safety will be back on the agenda big-time when the report of the Mid Staffs enquiry hits the streets. Rumour has it that the report will contain hundreds of recommendations. If it does it will miss the point. All we want to know is why the NHS, institutions and individuals from top to bottom, seemed to be looking the other way when it all went wrong. I hope part of the answer addresses the need for a profound change in the way clinical professionals view their roles and their responsibilities but I fear, instead, a further re-arrangement of the institutional deck chairs.
Thirdly, the desperate need to address acute service reconfiguration will pop up in some expected places and probably in many unexpected ones too. For decades we have predicted the terminal decline of the district general hospital. Many will be in their death throes in 2012. With clinical commissioning groups firmly in control; with a willingness on the part of the regulators to allow the return of service planning; and with the kind of political bottle that enabled Andrew Lansley to support the decision on Chase Farm Hospital, there is a chance that some tough decisions that have been too hot to handle in the past may be taken. However, my fear is that a combination of media frenzy and politician anxiety will see the system retreat back into the old culture of kicking the problem into the long grass and supporting unsustainable institutions with under-the-counter bungs.
Finally, I predict 2012 will be the year when the patient is given voice. But the big question is: will it be heard? It was great to hear Andrew Lansley, in his final speech of 2011, speak so knowledgeably and passionately about shared decision making; about patient choice being just one part of the picture not an end in itself; about patients being given real options and empowered to work together with their clinicians. This was all the right language, all the right sentiment but how can we make this mainstream? How can we ensure this is the way all care is offered and delivered, not just something undertaken by the enthusiasts?
During 2012 The Health Foundation will be doing its bit.
Firstly, we will capitalise on the very considerable momentum built in 2011 to promote shared decision making and supported self-management. With this in mind, we will carry out a programme to gain deep insight into the challenges around the changing role of medical professionals in their relationship with patients and use this insight to drive a wide debate. In tandem, we will give a much stronger focus to work on improving education and training because we believe this is critical. We will continue to make the case for shared decision-making and supported self-management drawing on the range of evidence we are producing and we will promote a series of web based resource centres for those who want to move to implementation.
Secondly, we will give a major boost to the Foundation's long-standing promotion of patient safety. In England, at least, we believe there is a risk patient safety drops down the agenda with the abolition of the National Patient Safety Agency, loss of corporate memory and capacity at SHA and PCT level and the focus on organisational change. Yet our work in this area remains groundbreaking. We will conduct a stock take of the external policy context across the UK in order to develop and deliver a high profile influencing programme to keep patient safety on the agenda over the coming year. We will utilise a wide range of coordinated activities to spear head action including: a major demonstration programme; a new ambitious online resource/network; a campaign aimed at junior doctors; commissioned research and work to influence the new architecture to support patient safety at the NHS Commissioning Board.
Thirdly, aware of the growing strategic healthcare agenda around issues of service configuration in local health economies, we will actively engage with senior leaders to understand the organisational and system challenges in order to lay the ground for a flagship whole health economy programme we plan to launch in 2013.