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60 seconds with… Chris Ham

We talk to Chris Ham, the chief executive of the King's Fund, about the future of the NHS.

What does the new government need to do to support the NHS? 

The new government should recognise the financial and service pressures facing the NHS and be realistic about what can be achieved with the resources likely to be available. It should continue to support the Five Year Forward View (FYFV) and sustainability and transformation plans (STPs) as the means for implementing the forward view at a local level. Tackling workforce shortages is becoming more urgent and this includes creating greater certainty for EU nationals working in the NHS. The claims of social care must also be recognised to shore up the current creaking system and to embrace the need for fundamental reform of social care funding and delivery. Both the NHS and social care will need additional funding, over and above commitments already made, if standards are to be maintained and in some cases improved. 

What should be the priorities for the NHS over the next twelve months? 

The immediate priority is to continue and complete work that has started to reduce deficits and get performance on key standards and targets back on track. This needs to happen alongside continuing efforts to reform how care is delivered through the new care models programme. I’ve been impressed by what I’ve seen in some of the PACS and MCPs and there is promising early evidence of the impact on rising demand for hospital care. Other areas need to learn from the vanguards and show the benefits for patients and service users of the new ways of working that the vanguards are introducing. Work to improve productivity is another priority, building on Lord Carter’s review and the actions now being taken to implement its findings. We’ll be publishing shortly a report on the GIRFT work that Tim Briggs is leading and are encouraged by what’s being achieved in this work. 

How achievable are the aims in the update of the FYFV? 

The update is understandably ambitious but the NHS and its partners will have to work heroically to deliver all of the commitments that have been made. One of the biggest challenges is lack of funding to support improvements in care when the additional resources allocated to the NHS are being used mainly to reduce deficits. Another is the capacity of NHS leaders and staff at a local level to improve operational performance as well as finding time to change how care is provided. The update is realistic about the work needed to get back on track in delivering standards like the four-hour A&E wait and the 18-week referral to treatment target, but it’s not clear that every area will succeed in doing so within the timeframes that have been set. 

What needs to be done to make STPs and ACOs successful? 

There are three priorities. First, the leadership and governance of STPs need to be strengthened. This means enabling experienced leaders to commit full time to work on STPs without the demands of the ‘day job’. It also means supporting leaders from partner organisations to collaborate in taking forward the implementation of STPs. Second, national bodies must deliver on their commitment to develop a single regulatory approach in their dealings with STPs and the NHS organisations involved in them. I keep on hearing this is not happening despite the best intentions of Simon Stevens, Jim Mackey and other national leaders. Third, every STP needs to be clear what its top priorities are and focus relentlessly on delivering these, rather than trying to do everything. 

Why can STPs and ACOs succeed where previous integration efforts have failed? 

STPs and ACOs are the right way forward for the NHS but there are many challenges in realising their potential. The current legal framework, deriving from the 2012 Health and Social Care Act, was designed mainly to promote competition rather than enable collaboration. Organisational arrangements in the NHS are complex and fragmented. Accountabilities are focused on organisations rather than systems. Leaders within the NHS are much more experienced in running organisations than leading across systems, and funding flows often do not support integrated care. I would expect some STPs to make real progress in the next two to three years while others will struggle. The nine areas identified as potential accountable care systems in the update of the five year forward view will be watched closely as they evolve. 

What work will The Kings’ Fund be doing in the next year? 

We will continue our work on STPs, ACOs and new care models. We will also complete a project designed to set out a vision for community services in the future and what must be done to deliver that vision. We are just scoping a new piece of work to explore the ‘social compact’ between the public and the NHS and how this might need to change. A key issue here is what are the responsibilities of patients and citizens - as well as their rights - in their relationship with the NHS. We will also build on our recent report with Don Berwick on front line care in the NHS and how this can be improved by clinical teams working with the support and commitment of trust leaders. Through our leadership and OD team, we will be helping the NHS develop the leadership styles and cultures required to sustain and transform the NHS.

(Image: c. The King's Fund)

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