Dear Wes…

Dear Wes Streeting,

First of all, congratulations on your party's victory! As the new Secretary of State for Health & Social Care, I’m sure you have a long list of things you are eager to get started with but remember to take a moment to reset and relax. You have quite the job ahead of you.

I’ve been a doctor for 28 years, and in that time I’ve seen the NHS have good days and bad, but the recent past has been particularly bruising. You’ve inherited your role at a low point, with long waiting lists, worn down staff, and overwhelmed GP surgeries, Emergency Departments, Wards, and Care Homes. I also suspect that there isn’t a whole lot of money to spare. 

Despite all of this, I have hope. You and your party bring the possibility of a fresh start, renewed energy and focus, and the chance to renew the covenant between the British people and their beloved NHS, by thinking differently. 

Your party has laid out some important policies in the manifesto:  shrinking waiting lists by incentivising out-of-hours provision and pooling resources between trusts, bringing in independent sector assistance, more rigorous workforce planning, and the formation of a National Care Service. You’ve also laid out some of your own ideas for the coming term, such as accelerating and disseminating successful innovation, empowering staff, harnessing new tech like AI, and encouraging whole system innovation. You won’t be surprised to hear that I’m in favour of this too. Might I suggest a few ideas that could help us achieve this aim?

Accelerating and Disseminating innovation

The NHS has every one of the components needed to be the leading innovative healthcare system on Earth, but appears stuck. New ideas struggle to make it beyond the pilot stage, successful innovations often can’t make it the short distance from one hospital to another, and startups struggle to keep pace with the never-ending changes in evidence requirements. 

If you want our government to “put our foot on the accelerator” and spread proven innovations across the whole NHS, you need to deepen the support for the National Innovation Accelerator and Clinical Entrepreneurs programme, Health Innovation Networks,, and Federated Data Platform, and ensure that standards are developed and enforced. At the same time, if we don’t make sure the staff understand innovation and there are clinician leaders ready to support it, we’ll remain stalled. Make innovation part of all healthcare training, and expand the efforts to identify and train current and future expert leaders. 

Empowering staff

It’s not just innovation that is stuck. Our staff are too. They are perfectly placed to understand what the problems are, but don’t have the time, resources, training, or workplace culture to build the solutions. This needs urgent attention.

Your party has pledged to address the workforce crisis by ensuring regular independent workforce planning across health and social care, as well as delivering a long-term workforce plan to train needed staff and get patients seen on time. Remember that we’re going to need new types of staff in that mix.

Over the past few years, we’ve had the Wachter Report, Topol Review, Goldacre Review, Long Term Workforce Plan, all making recommendations about developing new roles to support the transformation. Be that Clinical AI Fellows, Topol Fellows, NHS Data Analysts, or Clinical Informaticists Officers, we’ve made progress, but we need to be bolder. We have to do better, and move faster. 

I consider myself one of a new specialism inside healthcare - a clinician product manager, a doctor who practises medicine not through the patients I see but through the products I build. I see others: nurses who code, pharmacists who produce engaging online content, and physiotherapist entrepreneurs building companies to solve the problems they face. Specialisation in Medicine has always been driven by technological change, yet we have fallen behind. Help create opportunities in the NHS for the healthcare workers who want to adopt new ways of working and we’ll increase diversity of our workforce, stem the flow out of the workforce, and retain people that are able to practise at scale. This is how we do more with less.

Harnessing new technologies: Artificial Intelligence 

Specialists alone won’t do it. Without the right education and training for everyone we won’t be able to design, develop, and deploy new technologies. Patients and professionals alike need to understand AI. We need a national effort to develop the foundational knowledge upon which we can build. Undergraduate courses need to make teaching about data science, digital health, AI, and innovation part of the core curriculum, not an optional extra. Specialist training programmes need to adapt. As highlighted in the NHSE reports on understanding and developing healthcare workers’ confidence in AI, we need to develop education and training. Without it we will struggle to make the most of this Cognitive Revolution. With it, the UK could lead the world in the adoption of AI in healthcare.

Partnering with the Independent Sector & Industry

It’s very hard to talk about the independent sector and industry in the same breath as the NHS without being accused of trying to privatise it and accelerate a conversion to a US style system. The reality is far from that. Industry has an enormous amount to offer in terms of innovation and service provision, and stands ready to help. To do this, we urgently need to address the inability for data to move safely and securely across boundaries to allow for healthcare to be truly integrated. At a recent conference I sensed a common drive for those in industry to work together on building to common, high standards, and sharing best practice. Only yesterday I was at a gathering of Clinical Safety Officers working together on how to ensure AI can be safely deployed for patient benefit. All of this will in turn make it easier for the NHS to feel confident about change. I suspect you’ll come into criticism for holding your position here, so all I ask is that you stay strong.

Show us the way

Most of all, what I believe we need is visionary leadership. For too long we’ve had politicians talking about what we need to do, and how we need to do it. No-one has clearly explained WHY. 

At first glance this might seem obvious, but dig a little deeper and we appear to be divided on why we put our faith in the NHS. We shouldn’t be surprised: There has been no consistency of messaging, just an ever changing list of new plans, recycled ideas, and endless reforms. Without clarity, or a vision of what health and care in the UK would look and feel like, we are left without a destination. Our efforts pull in different directions and depend on external effort to be sustained. We have no idea if we are getting any closer to a better place. If I had just one thing to ask of you Wes, it would be this: help us understand the why again. Help us understand where we are going, and what it will feel like when we get there. Use your powers to shape the health and care sector to allow those of us working within it to work out how to do it, and to build and implement the products and services to get there. We have 14 years of darkness to emerge from. Show us the way out.