Looking forward

I’ve always found March the hardest month in the annual rhythms that define the NHS working year. Not only are we trying to close off the performance and financial requirements of the current year, we are also asking colleagues to finalise plans and budgets for the year ahead. As a result, for lots of people this is quite an intense time and a leadership challenge to make sure one has the right people concentrating on the here and now, whilst with protected time to look forward to the year ahead. It is one of the idiosyncrasies of the NHS, and the annual negotiation with government on the priorities and spending for the service for the year ahead, that we don’t get local budgets agreed until late March or even into April and May. It has always been challenging, but certainly the complexities of planning as systems and the financial outlook for the year make this year as difficult as many can remember. The announcement last week about the future of NHS England is a stark reminder of the significant proportion of public sector spending that goes into health, and its impact on the wider economy.

Whilst there is always more one wishes one could do, reflecting on the current year, I am super proud of what we’ve achieved. In the last two years, we’ll have delivered a 9.5% improvement in productivity, with another 4% targeted next. Alongside hitting our financial plan two years straight. All our waiting lists have reduced, and we’ve moved in the last few weeks into the top 20 trusts nationally for access in our Emergency Department, an achievement that is reflective of not just changes made in the hospital but some remarkable work from our colleagues in the community. Challenges we thought intractable, like addressing long waits for children in the community, are starting to show signs that improvement can be made. We’re part way through the implementation of our Electronic Patient Record, and we’ve launched the country’s first use of generative AI to analyse and use patient feedback for service improvement. The move to a more preventative model of delivering healthcare is starting to take shape; we’ve delivered more cholesterol-reducing drugs for those at high risk of heart attack and stroke than anywhere else in the country. And the fact that we now have the lowest maternal smoking rate and highest proportion of breast-feeding initiations in the South East is something of which to be incredibly proud. If anyone wants to see the ‘three shifts’ in action, they can now see them in real life in Buckinghamshire.

So what hope do we have for the future? Despite the successes above, the next year is going to be harder, and the reality is that as an organisation we are probably still running on too many fronts. Saying ‘no’ to taking on projects and focusing teams on a small number of high impact priorities is much harder than saying ‘yes’. We’ve continued to iterate our priorities around the three overall improvement goals of the organisation and shrunk down from six objectives to four.

For our goal of providing Outstanding Care, we going to specifically target the reduction of people needing a bed in an emergency. This is the most complex objective given this is not only providing alterative pathways of care but really reducing demand for services. Our year-on-year trajectory for this is good, and will hopefully take a significant step forward with the county’s creation of seven ‘integrated neighbourhood teams’. This will be the most challenging but the most exciting piece of work for next year as we build community teams and services around the distinct neighbourhoods of Buckinghamshire. I’ve been incredibly impressed by the commitment of all partners in the county who’ve made this agreement at the end of this year. We’ve also committed to improving how early we see people in their pathways. Not only is this a clear governmental commitment and priority, but we know that the one truth for working in care is that the earlier one finds and deals with an issue, the cheaper it is for the taxpayer and the better the outcome.

We have a strong commitment to creating Healthy Communities and have learnt much this year in trying to roll out blood pressure monitoring at scale, working with schools for direct pathways into healthcare careers, and prioritising access for those in our most deprived localities, especially when it comes to contact with children’s services. There is definitely more to support people to live healthier lives, including making it core business that whenever we have contact with a patient, we can support them with a variety of lifestyle choice improvements, not just managing their presenting complaint.

And finally in making the Trust a Great Place to Work, we continue our two-year programme of fewer people experiencing bullying and harassment. This is a complex issue which looks at several different strands of work. Fairness and inclusion; creating the right team culture; behaviours; leadership development; and specific intervention where needed. Our National Staff Survey results from 2024 are embargoed at time of writing, but we’ve definitely made progress over the last 12 months, especially compared with the rest of the sector. This is especially true when colleagues reflect on the support from their managers or if the organisation is perceived to act in a fair and inclusive way.

Our leadership challenge as we progress through March is how we are able to take what is likely to be an even tougher financial settlement and continue to focus on the elements of our business that we know are going to make the biggest difference to not only the people who work and receive care here, but to the health and wellbeing of the residents we serve. One of my key beliefs is that the purpose of the NHS is to look after the most vulnerable in our society. This means prioritising both resource and effort into groups who don’t often shout the loudest, and working with our many partners to align these goals. Whilst I don’t think I’ve ever been through a harder planning process, I also retain the hope that there’s never been such opportunity to achieve this.