Rhetoric and reality – that gap again

Nearly ten years ago, when I took the helm at National Voices, there was a Labour Government and the ink was barely dry on the NHS Constitution. The secretary of state Andy Burnham was setting out his vision for the NHS in a document called “From Good to Great” and consulting on proposals for a National Care Service. In the wake of the financial crash, the NHS chief executive was warning of the need for productivity savings of up to £20 billion – the so called “Nicholson Challenge”.

Meanwhile, National Voices had recently been established, with a generous grant from the Department of Health to link government with the multifarious voluntary sector and to “narrow the gap between the rhetoric and reality” when it came to creating a truly patient centred NHS.

What a different world we now live in! And yet consider the continuities: the financial pressures; the failure to sort out social care; breezy new ambitious plans for the NHS that fall down on the implementation.

Some things have got better. National Voices – together with our members – has been a central player in a movement that is changing the relationship between citizens and the health and care system. When I started as chief executive I used to encounter people who disagreed with our positions. That never happens now. The centrality and agency of the patient, service user and carer are reflected in legislation, policy, guidance and broader thinking. Shared decision making, care and support planning, peer support, social prescribing, co-production, personal budgets, integrated care, and so on and so forth. These have emerged from the sandal-wearing shadows into the sunlit mainstream.

Some things have got worse. Nine years of austerity combined with a damaging and unnecessary reorganisation of the NHS under Andrew Lansley have sometimes slowed, sometimes undermined and sometimes reversed progress that we would otherwise have seen in service improvement, health outcomes and the broader wellbeing of communities.

And there remains a big gap between rhetoric and reality. A genuinely citizen-focussed care system might now be a national objective, with some real substance behind it, as set out for example in NHS England’s universal model for personalised care. But is it yet an organising principle or even necessarily a real priority? Besides, no one has yet figured out how to translate policy reliably into practice in a highly complex health and care system for 55 million people, with or without distractions like Brexit. The rhetoric has never been better. The reality still lets too many people down.

So there will be plenty for my successor Charlotte Augst to tackle as she takes over from me next week. I got to know Charlotte well in her previous role coordinating the Richmond Group. She will be great! I am delighted to be handing her the reins and I wish her all the best.