Does Mark Britnell have the solution to the NHS 'crisis'? The NHS England chief executive candidate wants to tear down the separation between GPs, hospital doctors and social care.
The Foundation Trust Network has been gathering in Liverpool for its annual conference against a background of drift and crisis in the NHS. Like soothsayers in the dying days of a crumbling empire, the service is beset by reports and speeches predicting collapse. Harder to find are leadership and answers.
No week would be complete without another report telling us how many billions of pounds the NHS needs to save, how quickly it needs to do it, and how little chance it has of achieving it. This time it was Monitor's turn, with chief executive David Bennett warning that "the NHS must undergo radical change if it is to survive".
After many years of substantial improvements, mental health services are sliding into disarray. Research by the BBC and Community Care revealed average occupancy levels in acute adult and psychiatric intensive care beds of 100% – a crisis by any definition. Patients are in danger.
NHS England said this week that "London's hospitals are at breaking point". Just in case the message was unclear, it added that breaking point state of affairs was unsustainable.
Meanwhile NHS England chief executive Sir David Nicholson has been warning of the risk of a financial "cliff edge" as a result of the government's decision to establish a pooled "integration transformation fund" between the NHS and local authorities worth £3.8 billion in 2015-2016.
In a telling sign of his inability to control policy in the face of political interference, Nicholson was reduced to stating "my view" about what the money should be spent on – predictably light on social care – in a letter to NHS managers.
Just seven months after the reforms were put in place, bits of the system are already dying off. Another commissioning support unit is on theverge of collapse – this time Anglia – and more can be expected to follow.
Competition law is, predictably, playing havoc. The Health Service Journal revealed that the rules have derailed two major pathology organisations, trusts are being compelled to spend astonishing sums on legal fees to fight their way through the competition thicket in their efforts to respond to precisely the challenges laid down by Monitor and many, many others.
What is lacking is any sense of a way out of this mess. NHS England, after early signs that it would retain the "grip" personified by Nicholson, seems to have lost its way.
On Tuesday, in a move symptomatic of an organisation losing its nerve, NHS England scrapped its £50 million fund to promote innovation in specialised service commissioning just two months after it was launched.
Perhaps it is hardly surprising that leadership is so hard to find in system conceived as being localised and driven by the energies of market competition but instead increasingly look fractured, confused and directionless.
How timely, then, that NHS England chief executive candidate Mark Britnell, currently global head of health at KPMG, took to the Foundation Trust Network platform to kick around a few ideas just days before the interviews.
His globetrotting has exposed him to health systems in developing countries focused on flows, not boundaries between primary, secondary and tertiary, and that is clearly the thinking he wants to bring to the top job.
His focus on systems rather than institutions, departments and sectors instinctively feels right. He wants to tear down the separation between GPs, hospital doctors and social care.
The word crisis is thrown around a lot in the NHS. The biggest crisis is the want of a solution. A mass of organisations each flailing around to solve its own problems with little sense of cohesion or common purpose beyond institutional survival is greatly exacerbating the enormous clinical and financial pressures building up. The repeated talk of the Nicholson Challenge and the chimera of great strides in productivity are getting us nowhere. A new approach is required. Guardian Professional.