“NHS leaders looking to deliver change and transformation in their local health economy should be prepared to defend their plans in court, rather than pretending that the likelihood of legal action will never happen, Rob Webster, CEO at South West Yorkshire Partnership NHS FT, has warned.
Chairing a session entitled ‘Saving Our Services – Why are local campaigns fighting to save the NHS from transformation?’, at last week’s NHS Confed17, Webster, who is also the lead for West Yorkshire and Harrogate STP, said that even if the health service does “harness the power of communities, you can bet we will still have a fight with some people about change”.
“One of the lessons I’ve learnt,” said the former NHS Confed boss, “is so long as you have engaged with people throughout the process and have done it in the right way, and so long as you have some clinical and public voices behind the changes you want to make, and as long as you’re prepared to go to court, if and when you have to, and win, then the change will happen.
“Somebody will refer you either to the secretary of state or to a judicial review. Get ready for it, and work through it, rather than pretending it’ll never happen or thinking that if it happens it is the worst thing in the world. Get yourself ready and it will work.”
During the session, Webster asked panel members what they thought should be the priorities with regards to the STP and change agenda for the new government.
David Lock QC, former MP and legal advisor to the NHS, said: “STPs were an object lesson in how not to do public engagement.”
The idea that the NHS needed space to have honest conversations with itself before going out to the public created a huge deficit in public trust, he argued.
“The process and the constraints put on those running the process, and not to be public about what they were doing, was enormously damaging,” stated Lock. “If the ministers want to keep the STP process going on, they are going to have to do an awful lot more emphasis on bringing the public with them. In the end, you cannot deliver public services in the face of public opposition.”
Cllr Robert Smart, an advisor to the ‘Save the DGH campaign’ in Eastbourne, stated that the health secretary needs to slow down the process of the STPs “and make them into a proper 10-year strategic view”.
“And if that takes a couple of years to produce, then it takes a couple of years to produce,” he told the audience of delegates. “It isn’t a question of suddenly saying, ‘in three months’ time, we’re going to convert 40% of acute spending into community spending’.”
The following day, Jeremy Hunt admitted that, given the result of the latest general election and with the negotiations around Brexit starting just a couple of days ago, it is now unlikely that the government will be able to introduce legislation for STPs in the next few years – if at all.
Imelda Redmond, national director of Healthwatch England, also called on Hunt to “reward, and encourage, engagement with the public” on the STPs.
“It is number one on people’s agenda of what they love about the country, and what they care about,” she said. “Why would you not harness that, and get the best care we can?”
And Jeremy Taylor, CEO of National Voices, stated that the government must give the health and care system the resources it needs, and give it the time it needs to make change.
“There may be legal requirements on consultation, but there are also psychological requirements: you need time to build trust and relationships,” he reflected. “If you are doing this at breakneck speed it is just not possible to do it.”
However, NHS Improvement boss Jim Mackey also told the conference that it is possible to get “90% of the way there” with accountable care systems and accountable care organisations within the current legislative framework – “but we need to prove it”.
NHS England’s Simon Stevens later confirmed the nine areas that will officially form part of the first wave of ACSs.
Webster concluded by agreeing that time and resources are really important. “It sounds like you need to plan in the medium term and understand the money you have to do that. You could call it a sustainability and transformation partnership trying to bring everyone together,” he joked.
“I think it’s good that we have an audience that thinks it is not right to be dishonest or patronising. What we need to do is be honest and get alongside people and harness the power of communities.”