A year older and a year more confident

Abstract

The year will see Simon Stevens take over from Sir David Nicholson in April. He will arrive loaded with unrealistic expectations about how far and how fast he can provide a stronger sense of direction and strategy, and how far he can make instant changes. He will need all the support that anyone and everyone can give him. And for his first year in the job, he will have Hunt to deal with—the odds being strong that the health secretary will still be in his post come the general election. The position of Andy Burnham as his Labour opposite number is not so certain. One suspects that Ed Miliband will have one more chunky re-shuffle of his team ahead of the 2015 general election. Depending on how central Miliband decides to make the health service, and on which bits of ground he wants to stand, Burnham may or may not be there. It will be a year in which the new organisations that litter the landscape will be one year older and, doubtless, one year more confident. And it is a year that may well start to see some interesting variation in the way services are organised. That can only be a good thing. Newcastle foundation trust has already taken over or entered into partnership with a small number of GP practices. Birmingham is discussing the same. The Competition Commission permitting, some interesting experiments in vertical integration look to be on the way. Bids for the George Eliot hospital may see the independent sector take another stake in running NHS hospitals in the wake of Circle’s contract for Hinchingbrooke. The integrated care pilots will get up and running, and they will be evaluated, providing, it is hoped (though probably not be the end of the year), clearer evidence on how far they can improve services and whether they achieve better value for money or actually release cash. Bet that they may well do the former but are unlikely to do the latter. It will, of course, also be the year that runs up towards the May 2015 election, with any election more of less guaranteed to put the NHS centre-stage at some point, even if NHS matters have never yet been known to decide the result. Wars and terrorist attacks aside, the economy, stupid, will remain the central story. In NHS terms, that means the money. Will the hard landing financially that is almost certainly on the way happen in 2014? Or will the problem somehow be managed into 2015, just after the election? We will see. BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund, asks what 2014 holds following Lansley’s reforms and the run-up to the next election A year older and a year more confident