Niall Dickson CBE and Roy Lilley with their latest guest Rob Webster CBE For this next edition of In The Loop podcast Niall and Roy come together with Rob Webster one of the most prominent NHS managers and a huge advocate of integration. Rob heads up the West Yorkshire and Harrogate Health and Care Partnership an integrated care system. And like every other system in the country he is grappling with a huge financial challenge, a big reorganisation, redundancies and staff threatening industrial action. So how is he managing as he faces a 45% reduction is his workforce and key staff in an angry mood? Rob reveals this is the most frustrating period in his 36 year career with enormous pressure on everyone and he admits it is causing harm to his staff. But he insists it will not distract from the work. While he acknowledges the difficult financial position, he says the transition is incredibly difficult, supports the aims of the reorganisation and believes that close working relationships between health, local authorities and the third sector can and will deliver meaningful change.  He says the NHS must put its people first and argues that staff have quite rightly become dissatisfied and that the job of NHS leaders is to do something about this. He notes how painful it has been to see the attrition of standards over the past fifteen years but suggests this can be a period where the NHS has to recover and transform services.Niall and Roy remain concerned about what can be achieved given all the headwinds but here again is a leader who says they can make progress.This podcast was recorded before the government announced the go-ahead for widespread redundancies in ICBs and NHSE. Speaking at a Providers conference on 12th November the Secretary of State said; ‘...Funding arrangements [for voluntary redundancies] have been agreed with HM Treasury and will be from within the existing funding settlement. We will not be cutting any investment to the NHS frontline. Further detail will come forward in the coming weeks.’It is widely anticipated that NHS organisations will be permitted to overspend budgets in the current year and the amounts reclaimed over subsequent years through efficiency savings. Send us a text
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Episode 12 Sarah Woolnough
In their latest podcast Niall and Roy engage with Sarah Woolnough the Chief Executive of The King’s Fund, one of the country’s leading health think tanks. In a frank discussion, Sarah defends the role of think tanks and laments the government’s failure to embrace public health and prevention in its first year in office. She is highly critical too of the decision to kick the social care can down the road and says the Fund is now exploring radically different ways it could be funded, including social insurance.She is no fan either of the current reorganisation, arguing that she would have done it differently and quoting NHS leaders warning that it is already a major distraction. And she calls on the government to be honest about what it can and cannot be achieve within current funding constraints.Sarah reveals one of the most powerful moments she has had since joining the Fund: listening to leaders revealing the moral injury they have felt for not being totally transparent about their financial position for fear of being placed under greater performance scrutiny. And while she wishes pharmaceutical bosses better understood NHS funding challenges she understands their ‘immense frustration and anger’ because they feel the government has led them up the garden path.Send us a text
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Sir Jim Mackey, chief executive NHS England
EXCLUSIVESir Jim Mackey, Chief Executive NHS England in conversation with Niall Dickson & Roy Lilley... in a frank interview Sir Jim talks about the difficulties he is facing and the fact taking on what he thought would be the job and how it's actually worked out, are two very different things!In this wide ranging conversation he accepts the pending redundancies are a cause for great concern and says that he does not anticipate any compulsory redundancies although the time scales are still uncertain.Managing the complexity of reorganisation, the pressures to deliver waiting lists and the Ten Year Plan are all on his 'to-do-list'.Listen to how he prioritises and how he sees the future.Send us a text
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Episode 10 - Claire Murdoch
In their latest venture In the Loop, Niall and Roy turn to mental health and conduct the first interview with Claire Murdoch, NHS England’s outgoing mental health director since she dramatically resigned earlier this month after nearly ten years on the job.  In the podcast, Claire says she quit because she felt she no longer had political support and reveals her dismay at the failure of the new government to maintain the share of NHS spend on mental health. In a strong defence of what has been achieved on her watch, including more than doubling the number of professional staff working in child and adolescent services, much improved access for young people, despite a huge increase in demand, and great progress on a nationwide roll out of mental health support in schools. Looking forward, she says the share of NHS spend has been phenomenally helpful and must be protected and that as far as she is concerned it was ‘job begun not job done’. But this discussion also reflects the reality of mental health care in England today with services desperately struggling to meet the explosion in demand and with patients of all ages unable to access the support and treatment they need.Send us a text
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Episode 9 Dame Jennifer Dixon
The latest podcast from Niall and Roy sees a somewhat different take on the current state of the NHS from Dame Jennifer Dixon, the longstanding and respected Chief Executive of the Health Foundation. Jennifer, who once practised in paediatrics before moving into public health, accuses the government of being disrespectful and menacing in its approach as it seeks to reform the service and argues that the system needs to use its principal asset which is human capital. She also questions whether it will be possible to deliver all that is being promised, arguing that while technology will help it is possible to be unrealistic about what it will achieve.Dame Jennifer also questions whether the current approach to prevention will work suggesting that there is a limit to how much the NHS can do given its funding constraints and she warns that if autonomous Integrated Care Boards could go upstream and spend funds in that way it could be at the expense of basic services. She says that while we are not there yet, if improvements don’t come fast enough, we may get into a situation where we need to look at getting much more money into the system from some other routes.On her own profession, she says she understands why young doctors are angry but reveals how she saw at one hospital how disrespectful they were to their chief medical officer, switching off their online cameras and putting barbed comments in the chat box. Jennifer calls for much more practical support for resident doctors but predicts that technology will mean more tasks will be protocolised and that as a result in the future there may be a need for fewer physicians, with those who are there working at the top of their licences. The next five years she says will be the most critical in the NHS’s existence.Send us a text
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