Eyes on the prize: There is a workable future for the NHS, but its radical reforms need commitment from managers and politicians

Simon Stevens is an adroit performer and his speech to the NHS Confederation’s annual conference in Liverpool on Wednesday confirmed him as a smart, versatile and imaginative chief executive of NHS England. More than a year into the job, his popularity shows no sign of waning, which itself is some kind of record.Whether he can maintain it over the next five years is a moot point. Gloom is de rigueur when discussing the NHS and, on the latest evidence, the gloom can only get deeper.

First, however, let us examine the upside. Last year the NHS dealt with 600,000 more attendances at A&E than in the previous year, over 200,000 more emergency admissions to hospital and almost 190,000 extra urgent cancer referrals. It carried out an extra one million diagnostic tests and answered over four million extra calls to the NHS 111 line.

Not bad for a service perpetually “in crisis”. Unfortunately the crisis label is accurate. For despite its successes, demand in the NHS continues to run ahead of supply. As a result, waiting times are lengthening, hospitals and GPs are creaking, and budget deficits are increasing. No matter how fast it pedals, it cannot keep pace. Doing more of the same is no longer an option. As Mr Stevens reminded his audience of NHS managers there will be no more money this year. Reform is not merely desirable, it is utterly necessary to the NHS’s very survival.

That much was spelt out in the Five Year Forward View, the widely acclaimed blueprint for the future of the NHS published last October. In this week’s speech we got a sense of how it might be achieved.

The most eye-catching announcement was that three entire regions – in Essex, Devon and north Cumbria – were to get emergency support to turn the local health services in their areas around. Instead of targeting individual failing hospitals for Special Measures – sending in a hit squad to bang heads together – as in the past, the new strategy, rebranded as a Success Regime, involves taking the local health service as a whole, including GPs, hospitals, public health and social care, and seeing how each part of the system can combine to produce the best overall outcome.

It is no good trying to stop multiple leaks with a single sticking plaster. The huge gains in productivity needed over the next five years – far greater than any in the past – will only be achieved with a radical whole-system shift in the way care is organised – for example, by moving it out of hospital and into the community.

Nowhere are hopes higher for a radical shift of this kind than in Greater Manchester whose council won control in February of its £6bn budget for health and social care, the biggest such pooled budget in the country. Critics fear it will lead to more outsourcing and privatisation, but supporters believe it will provide a template for the future of the NHS.

But while the audience listened to their chief executive respectfully and attentively as he laid out his vision of the way ahead, one issue dominated all others, in their minds if not on the conference floor – the NHS budget.

Money is the abiding obsession of every manager in the hard-pressed service – how to save it, where to hide it, when to bring it out and spend it. The struggle to make ends meet, the daily firefighting to preserve a service in crisis, absorbs so much time and energy there is little to spare for big plans about reform.

The danger for the future is that the NHS’s leaders become so deeply entrenched in their struggle to keep it afloat this year and next that they lose sight of the tougher, longer, more challenging but ultimately more rewarding task of making it seaworthy for the next decade.