Beware the siren calls…

In the midst of delivering my second child, I got fleeting moments of respite. I caught glimpses of the future, and could envisage life with less pain, despite being up against what felt like impossible odds. During those brief moments I took a breather and actually listened to my calming, practical and empathetic midwife, Danielle. Danielle managed to simultaneously encourage and support me, whilst advising me what not to do and also fending off the doctors who were keen to intervene. She gave me much needed reassurance, confidence and guidance.     

I was reminded of this during Jim Mackey’s speech at the NHS Providers annual conference. He exuded a calming, practical and empathetic manner. He gave assurances to colleagues that as Chief Executive of NHS Improvement he would be with them, offering support and advice, and attempting to fend off less helpful interventions, as they struggle to deliver against a seemingly impossible set of priorities. He was also honest about his role as regulator and the limitations of what he could and couldn’t do. He would give providers the reassurance, confidence and guidance they needed, but it was for them to actually deliver.

As well as spelling out his style, he set out his priorities. This was both helpful and daunting. He acknowledged the context within which colleagues were operating. He indicated that he would like to set multi-year tariffs to enable providers to plan their recoveries, investments and disinvestments. He also recognised the need to develop new relationships with NHS England, emphasising the drivers of change in reviews such as Carter, Dalton and Rose, and also in delivering the Five Year Forward View. He saw action in two phases – the first, stabilise the system and the second, to secure longer-term sustainability.

I do hope Mr Mackey gets the space to deliver his ambitions. Unfortunately, being situated near Whitehall means you are closer to those that constantly want to add to your to do list. As Chief Executive of a very successful NHS foundation trust, he was able to act more freely and for the benefit of his local community. Northumbria doesn’t just come with beautiful scenery, it comes with useful distance too; this has been attributed, in part, to enabling significant innovation, not least the work with Northumbria County Council to buy out a costly PFI deal.

So, rather than add to his immediate to do list, I would like to suggest an item be taken off, for now.

Whilst at the above conference, I heard delegates talk about the NHS foundation trust policy. Some thought the policy had had its’ day and that priority should instead be given to delivering new care models. This view echoes that of Simon Stevens who called for an end to the foundation trust pipeline, and indeed Jeremy Hunt who now views CQC ratings of good or outstanding as the 'single definition of success', indicating potential changes in law to give NHS trusts the freedom traditionally only granted to an NHS foundation trust. Striking a different note, however, the Health Service Journal recently hosted a roundtable to discuss NHS foundation trusts’ future, with participants agreeing there was still something of the policy worth keeping.

And it’s this differing view that I support. Our work at the Health Foundation on the future of NHS foundation trust policy has found that the decision to be made is more nuanced than a clear cut ‘keep them’ or ‘scrap them’. As a fun activity for Mr Mackey to do over a rare and well deserved coffee break he could play our 'spot the difference' quiz. You and he will see from this that the differences in hard metrics are not clear.

But before jumping to the conclusion that the Secretary of State and Simon Stevens are right in wanting to stop the foundation trust pipeline, I would urge Mr Mackey to consider the softer evidence. Indeed, evidence that he brings himself from Northumbria. During our work, we often heard of the benefits brought by applying to be an NHS foundation trust. We were told that it resulted in positive changes to behaviour and mind sets. 

NHS foundation trust boards more often took responsibility for delivering services that their local communities needed. Rather than looking upwards for direction, they looked outwards for support and delivered many examples of excellence. And despite patchy results, many of those we worked with thought the new governance and accountability arrangements brought with the policy, could help Chief Executives really engage with their constituents and ensure services reflected local needs. We think this remains just as relevant today as it was when the policy was designed and is therefore something to be captured and nurtured. 

And, let us not forget that staff across the NHS, and national bodies, have committed time, energy and resources to pursue the aims of the NHS foundation trust policy for over thirteen years. So, Mr Mackey please resist the siren calls for the policy to be ditched. Instead, deploy your inner midwife and allow the system to deliver a refreshed policy with you, keeping the best bits, whilst reflecting today’s context and challenges.

Try our foundation trusts and NHS trusts 'spot the difference' quiz