To Whom it May Concern, Congratulations on your appointment as the next chief executive of NHS England. You take over an organisation in a volatile state, facing funding cuts, despite the government’s rhetoric.

To Whom it May Concern,

Congratulations on your appointment as the next chief executive of NHS England. You take over an organisation in a volatile state, facing funding cuts, despite the government’s rhetoric.

Top of your in-tray is the need to establish trust and confidence in NHS England. You take control of an organisation born out of legislation that very few wanted to be passed, not least the coalition government itself who, in their Programme for government declared in no uncertain terms that it would “stop the top-down reorganisations of the NHS that have got in the way of patient care”.

What followed was what your predecessor described as reforms so big they can be seen from space. Coupled with the disastrous decision taken by your organisation to suspend, albeit temporarily, children’s heart surgery at Leeds General Infirmary based on incomplete data, you have a job-and-a-half on your hands to establish NHS England’s credibility.

You take the helm of an organisation that is both battered and bruised. In the wake of the report by Robert Francis into the uncomfortable truths that Mid-Staffordshire NHS Trust highlighted, you have a fine line to balance between championing one of the greatest institutions in the world and being realistic about the need to ensure working in it is seen as a vocation as much as a straightforward job. In particular, you will need to lead the charge to re-inject the critical component of compassion into the service.

The Labour MP Ann Clwyd, appointed by the government to look at the way your organisation deals with complaints, has reported some shocking cases of treatment in the service which, whilst not reflective of the whole service, need to be dealt with. Examples include cases where patients’ families claimed their loved-ones were left in vomit and excrement, incidents where food and water was  left out of the reach of patients and one nurse who is reported to be have told a patient “I’m a graduate, I don’t do sick.”

The number of people being admitted to A and E units is also on the increase, not least as a result of a rushed introduction of the new 111 non-emergency number, which officials have argued was introduced before many NHS institutions were ready to handle the change. A letter leaked to the Independent from a group of 18 leaders of NHS A and E units has warned that a combination of “toxic overcrowding” and “institutional exhaustion” is putting lives at risk.

“What is entirely unacceptable is the delivery of unsafe care, but that is now the prospect we find ourselves facing on too frequent a basis,” the letter concludes.

According to the health secretary Jeremy Hunt, one of the main answers to the crisis engulfing our emergency departments is to increase the number of staff in Emergency Departments. And yet, as a result of this government’s cuts, it is feared that up to 60,000 NHS staff now risk losing their jobs, including many much needed nurses.

And finally, funding. The rhetoric from ministers is that they are protecting and increasing the NHS budget as a mark of the importance they argue that they place on the health service. But a letter sent from Andrew Dilnot, chair of the UK Statistics Authority, to the health secretary in December last year, explained that “expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.

You therefore need to navigate the realities of NHS cuts with the government’s bunker mentality that everything is rosy in the NHS financial garden.

I’m sure there is more I could write but, with that, I shall just wish you luck.

Yours sincerely,

Ed Jacobs

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