'If I were Health Secretary...' What do people in the service think Jeremy Hunt's priorities should be?

• We asked delegates at NHS Confederation’s annual conference ‘what should the Health Secretary’s shortlist of priorities be?’ 
• Around 60 senior leaders gave their views.
• Responses covered themes from the Five Year Forward View and hot topics such as mental health, funding, staffing and long-term population health.

Prioritisation for the health service is crucial – as Sir Alan Langlands once said: ‘when you have more than fifty priorities, the truth is that you have no priorities at all’. 

There are around 25 priorities in the current NHS England mandate, spanning a wide range of activity, including ‘make unprecedented efficiency savings’ – no easy or small task. It could be argued that this is still too many. 

The decisions the Health Secretary makes on his priorities for the system, and whether he sticks to them, will set the tone for the next five years. His priorities, and those of Simon Stevens, will influence whether or not the NHS Five Year Forward View (Forward View) is achieved. When given clear priorities the health service – rightly or wrongly – does respond to them. So what should the Health Secretary’s shortlist of priorities be?

We asked people at NHS Confederation’s annual conference this question, and around 60 senior leaders gave their views. The results make fascinating reading.

Responses ranged from the radical ‘start from a blank piece of paper’, ‘move social care budgets into the NHS to stop political gaming’, ‘e-practices where an avatar guides you through a virtual practice’ to the more recognisable ‘care closer to home’, ‘listen to patients and front-line staff more’. We even had one prescient response: ‘merge Monitor and TDA’!

Five year forward view

Around half of people’s priorities included themes from the Forward View: integration, prevention, moving services into the community, building efficient services and making care more person-centred. The Forward View clearly continues to be the main rallying call for the NHS – with strong support for the vision, particularly that of preventing illness rather than only treating it:

• ‘Refocus on community services – all I’ve heard ... is “health and social care”, and then people only talk about hospitals’
• ‘Improve integration and get rid of duplication’
• ‘Targeting early intervention for older people’
• ‘Invest in a programme of learning to deliver truly person-centred care’
• ‘Prevention rather than cure’.

Mental health

Linked to Forward View priorities, and reflecting continuing concern about mental health services, a number of people prioritised mental health. It was often mentioned as part of an integration agenda – integrating mental health into all health pathways, and ensuring the physical health needs of people receiving mental health care are met. The thorny questions of mental health investment and beds were also raised.

Funding

There was a clear plea to the Health Secretary to fund the NHS adequately: ‘Ensure the NHS is funded to meet the needs of the population – with no strings! Be honest to the nation!’, ‘Right levels of funding available for services’, ‘focus on funding for staff’, ‘health care for all, free at the point of use!’.

Recent announcements have made clear that while there will be annual budget increases rising to £8bn in 2020, there will be no further funding this year. This leaves the NHS in an extremely challenging position financially, with big efficiencies to find. A few delegates proposed other ways to meet the NHS’s financial problems: ‘Charge for Did Not Attends!’, ‘Open up the debate of service rationalisation – can’t offer everything (!)’.

Staff

The other major theme was NHS staff – particularly supporting them, and making their work easier. This may reflect an increasing consensus that staff are feeling pressured and disengaged, and sustainable health services will need to provide the conditions for an engaged and happy workforce:

• ‘Recognise that looking after staff is the only way to good care. Staff need systematic support’
• ‘Greater value placed on the fantastic staff in the NHS – especially our nursing staff!’
• ‘Invest in leadership’
• ‘New approaches to developing staff’.

Priorities for change

Our Future NHS publication sets out the areas we think the health system needs to prioritise over the next five years and beyond – layering immediate issues like balancing the budget this year with longer term gains in population health. We believe that whatever happens, prioritisation is crucial. Any action takes attention and resource away from everything else that could be done: so it had better be the right one.

For effective prioritisation evidence is needed, alongside a thorough understanding of implementation. As one person remarked, perhaps the most important thing for the health secretary is to: ‘Think how to really make change happen, learning from the past twenty years and the wisdom across the globe’.