Goodbye to EU

Author: Niall Dickson, chief executive of the NHS Confederation.

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As we leave the European Union, and with the threat of a ‘no deal’ having receded, there is now a danger that we think it is all over. For the NHS and the wider health sector this is very far from the case.

With Sir Hugh Taylor, I have chaired the Brexit Health Alliance for two and a half years and I am proud of what we and our members have achieved with our partners in public health, professional and patient groups, research organisations and industry.  We work closely with the UK government, the centre of the NHS, our permanent representative in Brussels and we have brought our concerns about patients to EU decision makers.

But the challenge of the next eleven months will be just as great as it has been up until now, not least if we are to make sure that health continues to be a priority in the negotiations to define the UK's future relationship with our closest neighbours in the EU.  We will be lobbying on four broad fronts - patient safety; access to medicines and medical devices; patient rights to treatment and continued co-operation on medical research. They all matter, and time is not on any of our sides.

For more detail please see the Brexit Health Alliance webpage and do let me know if you or one of your team would be interested in joining our reference group which has already played a key role in feeding back advice to the centre on issues which affect your staff and patients.  We also jointly lead the Cavendish Coalition which is campaigning hard on the critical staffing issues – again more detail is available on the Cavendish Coalition webpage.
 
A new order

It has been another week of advance for Integrated Care Systems with the publication of the planning guidance this week.  The new mantra from the centre, ‘systems-by-default’, underlines the determination to use ICSs as the driving force for the NHS Long Term Plan. 

Providing NHS England and NHS Improvement is serious about devolving responsibility, this is an obvious and sensible step.

But we should be under no illusion about the fragility and variability of these relatively new entities.  In many areas, there is much to do in building trust and confidence even among NHS partners, never mind local government and the voluntary sectors. The hard wiring of organisational accountability continues to hamper collaboration and as services come under intolerable pressure, it is hardly surprising that leaders are compelled to focus on the here and now of their own services.
 
As the attitudes and behaviours within the service need to change, so too does the way the centre needs to interact with the frontline. And to be fair, this does seem to be understood by senior figures in NHSEI. These are, and will continue to be evolving relationships.
 
As a contribution to this debate, this week we published a report reflecting a discussion among a group of system leaders on accountability – Delivering together: Developing effective accountability in integrated care systems.  It is far from being a definitive document on what is required in this complex area, but it makes a powerful case for a new and more mature relationship between the centre and the service, including how the new regions will support the new world.
 
The observant among you may also have spotted a one sentence commitment in the planning guidance to part fund system infrastructure. This could be significant, and it is something we called for in our recent report Accelerating Transformation which found that despite positive work in systems across the country, piecemeal funding was restricting their ability to invest in the staff and infrastructure needed to drive transformation.  Presumably more detail on this will follow, but the promise is most welcome.
 
We will also want to explore more how the new performance management role for ICSs will work in practice.  Unsurprisingly, our impression is that there are mixed views within systems about this and some nervousness, especially among those where relationships are not as robust as they might be.
 
And it is among those STPs where partnership is stronger in name than in reality where additional support from the regions and the centre could be helpful with a clear and defined support offer for the journey to a meaningful ICS status by April 2021.

BME Leadership Network
 
Last year we set up a BME Leadership Network and it held its second meeting this week securing the enthusiastic support of Prerana Issar, NHSEI’s Chief People Officer.
 
Equality, diversity and inclusion will be a key part of the People Plan and the service will increasingly be judged on its efforts to develop and support all its staff, including how it develops the leaders of the future. 
 
The Confederation’s leaders’ network is a modest initiative but as Prerana said this week, networks work so if you can encourage your BME leaders and, just as important, aspiring BME leaders to take part that would be great!  
This blog was first published on NHS Voices, the NHS Confederation's blog for NHS leaders.
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