10 INTERVIEW RICHARD MURRAY struggled for so many years. It’s quite hard to turn around something the size of the NHS, and quickly. There remains a risk that people will be disappointed about how progress can be made,’ he says. ‘There aren’t enough staff’ Fulfilling the long-term plan will, Mr Murray says, be especially challenging given the workforce problem in the NHS. ‘The workforce issue sits as a black cloud on a lot of the long-term plan,’ he says. ‘There are going to be some difficult decisions – not because there isn’t enough money but because there aren’t enough staff.’ NHS England has announced there will also be a separate document focusing on staffing – the workforce implementation plan – later this year. Mr Murray believes that understanding how other systems work could help improve the NHS and that there are some clinical professions where staff are not in such short supply and that can be used to aid the workforce situation. Although it is now becoming more common for the general practice team to incorporate professionals such as pharmacists, mental health therapists and physician associates, Mr Murray feels the health system could do more on this front. ‘If you look at countries such as the Netherlands, physiotherapists are routine members of primary care. Things like this will take the pressure off staff,’ he says. Mr Murray also believes there is room for improvement on pay and that there might be a need for movement on pensions, particularly for older, more senior staff. ‘The workforce situation is a whole menu: what do we do about retention? What do we do about recruitment and training? Also, it will be key to bring back the continuing professional development (CPD) budget and refund the cuts,’ he says. International recruitment will be essential, he adds. ‘In the short term, we need to look again at international recruitment, which has been the traditional route for the NHS in the past,’ he says. With the effects of Brexit still unknown, he thinks the Government needs to ensure European Union citizens can easily come to the UK to work. ‘For a lot of European staff, we’re not attractive at the moment; they don’t want to come here,’ he says. However, he also considers that trusts and other NHS organisations need to be more ethical in their approach to recruiting staff from countries outside of the EU. ‘You can’t steal all the staff from countries with lower incomes than we have. However, there are ethical ways of doing it and it needs more central co-ordination than we’ve seen in the past,’ he says. ‘We need to get to grips with social care’ Another document that has been delayed is the adult social care green paper. Healthcare Leader 2019 Issue 10 Mr Murray addresses the initial challenge for social care, which is by no means a small one: money. ‘Social care has a short-term challenge, which is: will there be enough money next year and the year after?’ he says. Just as the workforce issue is prominent in the NHS it is, Mr Murray highlights, also an urgent problem in social care. He believes the Government needs to set aside a greater pot of funding for social care. ‘The workforce problem in social care is different from that in health, but it’s undoubtedly there. It’s more of a funding issue – if you put more money into social care and pay people more, you will probably get more people willing to do it,’ he says. ‘We need more money for social care in the next budget. We need to find a more sustainable solution for social care that helps bring it closer to the NHS but, most critically, sorts out the long-term funding problem,’ he explains. He adds: ‘This has been kicked down the road by successive governments that never quite got around to sorting it out. ‘But other countries have managed it. This is not impossible – we need a government to grip this problem and manage the short-term rather than let things slide further than they already have. The Government needs to come up with permanent solutions that will ‘We need health and social care combined – a comprehensive approach across both services. We need to think about where the assets lie. It’s not all bleak,’ he says. ‘Be ready to support local leaders’ Mr Murray acknowledges that the high rate of leadership change in the NHS is a cause for concern and that there are a number of reasons the health service is not great at holding on to its leaders. ‘The expectations on senior leaders to try and find solutions at a local level are just too great. They’re being handed unmanageable problems,’ he says. He also thinks the blame culture in the system needs to be addressed before it drives more people away. ‘Sometimes the blame culture makes people say, “I don’t want to do this.” That needs to be turned around.’ In light of this, he is pleased to see the long-term plan address the need for ‘compassionate leadership’. ‘This isn’t soft leadership,’ he says. ‘It is an attempt to alter some of the cultures within the NHS – and that’s great.’ When asked what NHS leaders need from policymakers, Mr Murray says: ‘Do not force unrealistic expectations on local leaders that they can’t deliver. When you want major change, the reconfiguration of stroke services, for example, be ready to support them.’ It’s hard to turn around something the size of the NHS quickly get social care out of this never-ending Cinderella status.’ When asked why health policy has not been delivering in recent years, Mr Murray points to a number of issues. ‘There has been a lot of very unrealistic planning, with people trying to work out breathtaking ways to save money that would keep finances and services running smoothly, but they just couldn’t be delivered,’ he says. Mr Murray adds that in order to help the NHS move forward and prevent the current strained situation from escalating into a full-blown crisis, the health sector must work more closely with social care. He also believes support is pivotal in helping the wider workforce. ‘Don’t overburden staff with must-dos. Be ready to support local leaders when they’re facing real challenges about performance,’ he says. He is convinced that leadership is vital in order for the NHS to offer the best services it possibly can. ‘Leadership is such a rare commodity – you need to nurture it and you need to support it,’ he says. Although he has only been The King’s Fund’s chief executive for a few months, Mr Murray is keen to step up and address some of the key problems that are hindering the NHS from prospering.