Who will take the lead amid calls for NHS clarity?

I spent a whole day last week taking part in some fascinating discussions about the future of the NHS in London and how to communicate the vision and strategy associated with this.

Luke Blair: 'Long term, strategic' thinking is needed
Luke Blair: 'Long term, strategic' thinking is needed
First, I was at a breakfast roundtable organised by New London Architecture about what to do with the huge amount of NHS estate in the capital – it is equivalent to about 1.5 sq miles – so if you put it all in one place, it would more than cover the City of London area.  

As hospitals consolidate, budgets come under pressure, and GPs assess facilities for local services, this enormous publicly-owned property asset will play an important role.

Secondly, I went along to the London Health Conference where I sat in on some seminars and did the usual networking around the exhibition.  Not surprisingly perhaps the themes this year included GPs, innovation, and communication.  

What was interesting about both of these events was the number of calls being made by speakers and contributors for a pan-London strategic view and how this should be communicated across the capital – in just the way that NHS London has been doing for the last six years.  

Naturally, as clinicians, NHS managers, health officials and others all rush in – or in some cases more passively find themselves being sucked in – to fill the vacuum left by NHS London and the 31 former Primary Care Trusts now being transitioned to new bodies, we should expect to hear some of this.

No-one likes to follow a pied piper without some sense at least of where they are heading, even if it is towards their own abolition.

But these were not just calls for someone to point them in the right direction.  These were calls, consistently made, for clarity, for vision, for leadership.  

And though it did not always please everyone all of the time, the soon-to-be-deceased NHS London did among its senior ranks have impressive leaders, with real vision, strategy and charisma, who from 2006 on steered a sizeable chunk of the third biggest organisation in the world in the right direction.  

The fact that London is now the best place in the world to have a stroke, and that hundreds of lives are being saved every year as a result, is one hell of a legacy.  

I have even recently seen one MP admit publicly that he was wrong to oppose this reconfiguration of stroke services when it was first mooted.

The question now though is who will take over this legacy, and become the new leader – or leaders – of the NHS in London, and who will communicate this?

There are some impressive contenders among the leading consortia of GPs which are now forming, some of whom I heard speak last week.  

Many are natural communicators, who clearly have a well developed ‘bedside manner’ and can use this to convey genuinely exciting new ways of delivering better care.

Some of the more forward-thinking local government leaders and officials are also proactively picking up the NHS baton to take over where Ruth Carnall and Lord Darzi left off.

And what about the Mayor?  Boris tends to say NHS decisions are best left to clinicians and yet, just as in aviation, why should he not also be taking a stronger lead on this critical issue for London?

Why not use the power and influence of City Hall to bring together the new Health and Wellbeing Boards on councils across London, to share best practice and re-create the kind of London-wide strategic thinking which the best brains at NHS London used to epitomize.

In the meantime, those decisions he says are best left to clinicians will carry on having to happen.  

Events in South East London have proved that where reconfigurations do not quite work for whatever reason, the situation becomes critical, chickens rapidly come home to roost, and the administrator has to be brought in.

What London clearly needs to do is not to allow its NHS services to head towards failure in the first place, but take long term, strategic decisions which allow clinicians, GPs, local authority leaders and others to plan properly, for the future, and communicate that they are doing so.

The problem as ever is that these strategic decisions are hard, complex, and in most cases require not just brilliant communicators, but also real political bravery, real conviction, and real charisma.  

Which is what leadership is all about.

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