You do sort of vaguely know the persona of a fairly new Secretary of State for Health. Don’t you? Or you at least have an opinion? The last one was there for ever, and seemed to be ensconced for ever. Came over very well at Health Chat a couple of years ago. I’ve seen the politician more than once on TV – a good performance on Andrew Marr, I thought. But what makes him tick? The back story is always what we hope for when Roy Lilley calmly digs deep.
The RSM lecture theatre was packed. 200, and many more on Periscope. (If you want to view yourself, click through here – free to watch).
Everyone wants a piece of a Secretary of State. One of the youngest FabNHS Ambassadors managed to interview him before the main event! She asked him “If you had my sixth form friends here now, what would you say to them to seek a career in the NHS?” A very full answer. And you can hear the passion, conviction and sincerity. That is easy to spot if it is fake. And I was heartened to see that it really isn’t. (Not sure if tech will work – but you could hit here and I hope it does!)
Just an hour – it’s a bit busy being a cabinet minister at the moment. It surely must frustrate them all as one thing dominates the agenda as we speak. But Matt Hancock does seem to be getting things moving, just perhaps slightly more slowly than he would like? Usual level of jibe from Roy about going to a posh school. He also went to a Further Ed college. Good service return, I thought.
Why politics- when you could have got a good job (yes, we are used to Roy’s style…). As is very often the case, a youthful experience created that. A sense of injustice engendered when his parents small business almost stopped existing whilst awaiting payment from their only customer who had been caught in recessionary pressures themselves. Cheque arrived on the Wednesday before closure would have happened on the Friday. Not just the family, and their home, but a dozen employees too. And no fault of their own. Out of their control. He first became an Economist at Bank of England. Swiftly realised economic change decisions were made up the road at Westminster. So driven towards that.
Interesting family business too – software design. Their piece is data management of Post Codes. When you look up a postcode on line, it is their software that does it. This sort of experience may be useful in his current role…
I liked his focus on big issues rather than Lansley style micro managing and imposition without consultation ( in my view). He was very impressed with the people in the NHS and the results they achieve. But the fact that they are undervalued really seemed to annoy him. There is a need to change morale through better leadership. Sometimes simple things can help, like taking catering back in house at his local hospital. Better food for both patients and staff. Everyone happier. And feeling valued.
Before we delved too deeply into policy, I think we had an insight into the ministers NHS drive. The NHS is there for everybody. The 1.3 million employees, in all the jobs and professions (not just the doctors and nurses) have one main overarching aim – to save lives. There aren’t many jobs with that level of reason for being. He wants everyone empowered to make sure the whole NHS and social care is the best it can be. The NHS team members are duty led and are driven by their duty of care. And if they feel undervalued, then it is his priority to help address that.
All this came over as both part of his core value set and was very sincere. He really did come over as passionate about the role and the influence he will be able to have. I felt it was very real – cynics amongst you may mock, but I really don’t think you can fake that level of commitment. It bodes well. He seems to relish the challenge, which is good for all of us?
But it is an immensely wide brief, as we know. Some highlights, with potential to become lowlights….
- The Money: well yes we are talking about getting back to funding growth growing again at historical levels of 3.6%. As Matt pointed out, this means it will grow from £115 billion today to £148 billion in the fifth year of the funding plan. And there is the rub – same percent off a higher base, more real money? Healthcare inflation is higher than normal life inflation though? And we didn’t get too deeply into Social care and the ageing population. (Except a Green Paper due before April). The positive is that the funding was for 5 years, not a year at a time. The money graph has at least changed direction, with his push. He touched on debt, and the prospect that the unrecoverable debt (possibly 1/3rd of Trusts?) may be taken out somehow. Just a hint that PFI debt was in his sights. I do hope so. He also wanted people to work at breaking even with the annual funding provision. But the 5 year deal means at least people didn’t have to plan for unrealistic payback schedules of less than 1 year. He understands economics, spreadsheets and business plans. Hoo-ray! Getting people to make sure the cash flow is right, and worrying less about the balance sheet. Other things waste the money resource. The aim is to have fewer Pilot schemes, and more finding out what works and sharing it and rolling it out. (Akin to FabNHS ideology?). They both discussed prevention as an obvious strategy, to get ahead of the demand curve. If we can get the capital versus revenue argument switched, there is a better chance of balancing the health economy. And getting the flow balanced is actively motivating for all.
- “Digital. It’s a mess. Discuss”. (Roy being a bit in yer face, I thought!). Most interesting thoughts here were around sharing of data. A lot of the legacy contracts means the 4 major providers (?) of systems for GP land seem to own the data and will not share. He has already made sure that new contracts don’t have that. There must be a way of making the old contracts open? Could it be as simple as asking the contractor to be open and share the data, or they will not be awarded any new contracts anywhere within the NHS or social care? When you’ve got them by the wallet, hearts and minds usually follow. Just an idea…. That’s before we get into Interoperability. After another sensitive interruption, as we got into whether the 10 year plan was a set of hopes or a real action plan (the protagonists begged to differ, but carried on anyway – even though Matt did say that he nearly swore at that point!). Faxes were brought up. “But they work” said Roy. “So do pigeons – but I think we have progressed.” Good answer – which got both laughter and applause. The data migration to interoperable systems may still be the biggest roadblock?
- “Why have a plan with no workforce plan within it?” That feels like the implementation part of the 10 year plan. Training takes time, of course. We may need to have different types of people. Nurse apprentices seem to have become more difficult with the introduction of the Apprentice Levy. But many hospitals have started training their own doctors nurses and more possibly, as they became despondent of waiting for Health Education England to get their house in order. Matt also seemed to be in favour of doing things differently – like changing the Primary Care model to include both types of model. The digital, machine learning algorithm led GP at hand style, as well as the traditional format. High Quality access is still the aim, it is all about horses for courses. Same meat, different gravy? It also sounded like technology could be central to all this. Getting NHS England, Improvement and Digital into one amalgamated entity seemed to be part of the process thinking.
Far reaching, thought provoking and very enlightening. I’m still unsure what NHS X was all about (some research needed here!). What I am sure about is that the Secretary of State will make a difference. He already is doing so. His background and core values seem very congruent with today’s needs. I came away feeling very positive. There is still so much to do, of course. But suddenly, it doesn’t feel quite so scary.