Jaws in Space 2 – Johnny Marshall

If the first half of last month’s FDG meeting caused an acute exacerbation of my Stockholm Syndrome then the second half offered hope of some relief. Having a vision for the NHS seems to have become somewhat unfashionable, Spice World (1997) set to the Sound of Music (1965). Yet if we are unable to imagine, and agree, what the future could, or even should look like, then how are we going to plan for and build it? If we are going to allow the imagination of newly empowered clinicians to design the NHS what sort of Impressionism will we witness? Or will innovation be determined by national bodies resulting in something that is more akin to painting by numbers, with all it’s inherent strengths and weaknesses?

In June this year I came away from my first NHS Confederation conference with Malcolm Grant’s words on the style of the NHS CB ringing in my ears, “NO MORE TOP DOWN!” However, this seemed to be at odds with Dame Ruth Carnell’s comments the previous day, when talking about major service reconfiguration, reasserting the value of a top down approach. Yet I am fairly certain that I heard Sir David Nicholson give plaudits to both of them. The ringing in my ears was soon surpassed by an aching in my frontal cortex as I wondered where this really left the NHS, somewhere between Animal Farm (1957) and 1984 (1984)?

In reality of course the polarisation of the debate belittles its complexity. Perhaps one significant underlying source of both the failure or success of previous visions for the NHS is the degree of connection between national and local voices within the NHS and the degree to which the public voice has been suppressed or augmented. Which in itself is an over simplification akin to gravity plating in Star Trek (1979). However, I also came away from the NHS Confederation conference challenged by Ben Page, CEO Ipsos MORI, who politely suggested that the NHS would be better off explaining the benefits it is seeking to achieve before asking everyone what they thought of its solutions.

This thread has been running through a series of FDG meetings – considering what role the NHSCB might take in supporting a national dialogue that connects the national and local leadership with the public in search of a broad brush vision for the NHS that Cheryl could articulate to Simon, the nation’s very own My Fair Lady (1964)  bringing the The Truman Show (1998) to the NHS in the hope of unlocking the potential of The Social Network (2010). Arguably, the secret, and greatest challenge, to success lies in the collective nature of such a vision. It will require aligning leadership throughout the NHS but crucially also well beyond. Whilst it would not be difficult to argue that this is somewhat overdue, on the face of it the task is formidable.

If the NHS is to add years to life through better health outcomes and financial sustainability, in the midst of the longest recession since World War 2, then it will need to undergo significant service reconfiguration. The planning and building stages of any vision will bring their own challenges, such as delivering integrated care with the current NHS IT infrastructure – if not Mission Impossible (1996) then certainly much harder than it could be. The longer we delay the inevitable the more difficult the task will become.

To stand a chance of achieving this then CCGs will need to work with each other across larger population sizes. The NHS CB and CCGs will need to coordinate their commissioning operations to best effect for their shared population and also oversee coordinated infrastructure development. Critically both will need to engage with the population to agree a common understanding of what needs to be achieved and a common currency for both articulating the intended benefits and with which to measure the outcomes. The perfect antidote for my Stockholm Syndrome?

On the way home that evening there was a storm whilst the train was standing at Grantham Station. Dark skies tricked the street lights in to a false start and provided an appropriate back drop to spectacular lightning strikes just the other side of the tracks. As we travelled further south, the clouds lightened and then broke resulting in glorious blue skies. With my Stockholm Syndrome now a distant memory I reflected on whether The Perfect Storm (2000) had served as an Omen (1976) for the journey that we are all embarking on!

The End (2008)

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