You may have enjoyed two or three as you sat at an outside table in a whitewashed taverna, shaded from the summer sunshine by a simple blue and white canopy. As the sea lapped against the taverna’s harbourside pontoons, perhaps there may have been a bottle of local white wine propped in an ice bucket at the side of your table. You’d have been handed the menu, and your eyes might have lasered in on the starters section where they may have alighted on ‘soft shell crab’. Mine certainly would have done – they are one of my absolute favourites, first tried at a crab shack adjacent to the Potomac River in Washington DC and a taste revelation never forgotten. The texture is bordering on unique, with a slight crunch giving way to softness and then more gentle layers of crunch. And then there is the taste – a sweetness blended with salinity and, if you are smart to request it, a little bay seasoning sprinkled over the top.

There you are – that will have you salivating all morning, assuming that you are least a pescatarian. Apologies to the vegetarians and vegans out there, but I needed to share this with you, for reasons that will become clear.

Soft shell crabs are harvested at specific times of their life cycle, as they undertake the process of molting. As the crab grows, its hard exoskeletal shell begins to inhibit further development, so Mother Nature has devised the process whereby the old shell is discarded and a new one grows in its place, able to accommodate the increased bulk. Once the old shell has been discarded, the crab takes time for its new shell to harden – and that is when the fisherman takes the harvest.

I invite you to consider the NHS and social care as a large crab. It has, at various times in its existence, fed well and its size and strength has developed. It has molted several times over the years, occasionally adopting very peculiar new shells (thank you Andrew Lansley), but it has lived on. Now it’s a giant, but another molting has happened, and it’s been a struggle. The old shell of NHS England was consigned to the seabed earlier this year and the beast now hides, naked, awaiting its new shell to harden so that it can go about its work confidently protected against attack. Trouble is, it’s been nearly 4 months now and the shell is simply not hardening. The continuing nakedness means that it lacks the strength or confidence to function properly and is vulnerable to all sorts of perils. Many of you reading this will be familiar with those perils – poor morale, disaffected workforce, inadequate resources, lack of clarity and direction, and, above all, continued service user disappointment.

If next week’s promised launch of the 10-year plan is expected to be the shell hardening catalyst to finally get the beast operating again, then I’m anxious. The three central shifts that we know will form the foundation of the new plan (hospital to community, analogue to digital and treatment to prevention) are themes that we have all been addressing for the last 20 years. Most of you will be able to point to case studies in your own organisation that directly and successfully address them. The plan is expected to go big on the NHS App and AI. It is expected to demand reform and redirection. It is expected to put efficiency at the epicentre. You and I both know, from bitter experience, that these outcomes need time as well as skilled, capable people and the freedom to act.

In my view the crab doesn’t need and can’t afford to wait for a spectacular new shell that will be 10 years in the making. It needs something functional, safe, and effective to get it operating now and for the next couple of years. Otherwise, it risks being snagged in a net and drawn up to be the piece de resistance on a hot shellfish platter.

I’ve suddenly lost my appetite.

Stay safe, stay strong, and thank you for the brilliant work you are all doing.

Jon Wilks

CEO

IHSCM