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Radical changes are needed – my reflections on themes from the NHS Confederation conference

  • 27 Jun 2012
  • 4-min read

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Many people at the NHS Confederation annual conference last week remarked that it seemed quieter than usual. Perhaps not surprising given the current demands and pressures on NHS leaders, such as handling the doctors’ industrial action, staff facing job losses and many managers being uncertain about their own futures. These demands and pressures do not bode well for addressing one of the key challenges highlighted at the conference – the need for radical service change.

Ruth Carnall, Chief Executive of NHS London, highlighted clinical involvement as one of the keys to successful reconfigurations in London. But with staff morale approaching an all-time low, it is unclear whether clinicians have the appetite to lead major service changes, particularly in the face of public opposition. This will no doubt be the first of many farewell speeches from Ruth – including one at the Fund later this year. Her insights into the role played by strategic health authorities also exposed the gap in strategic leadership that has opened up in the restructured NHS. It is unclear whether clinical commissioning groups working together can fill this gap and drive through reconfigurations across large populations.

We have argued that the changes needed to meet the productivity gains on the scale required must be transformational. Mike Farrar echoed these sentiments in his speech, urging organisations to work together rather than in the narrow interests of their own organisations. The test of these new reforms will be whether the CCGs can engage clinicians in new ways across the primary and secondary care divide, but also engage with local authorities on public health, social care and children’s services. It is imperative that foundation trusts gain a broader vision of success – one that is not based on growth, but on delivering high-quality care and improvements to the health of the population as a whole.

It will be critical for politicians to have the courage to lead public debate about the need for hospitals to downsize and, in some cases, close. Stephen Dorrell quoted from the famous Water Towers speech, given by Enoch Powell as Minister of Health, who said, ’We have to get the idea into our heads that a hospital is a shell, a framework, however complex, to contain certain processes, and when the processes change or are superseded, then the shell must most probably be scrapped and the framework dismantled’. Unfortunately the current Secretary of State for Health, Andrew Lansley, did not show such political courage, but stuck instead to his four tests and the claim that these were matters for local resolution. In contrast, the government has been bolder this week in its decision to address the longstanding problems in South London by bringing in the administrators.

Much credit has been given to David Nicholson for naming the challenge of the £20 billion productivity gap. At this conference he came close to naming the challenge of potentially closing hospitals too, but he did not define the scale of the radical service change needed. It seems even he is unwilling to put a number on how many hospital beds will need to close.

The financial and clinical case for change seemed clear enough to most at the NHS Confederation conference, but the argument still needs to be won with the public and the wider staff working in the NHS.

It was scandals in mental health some ten or more years later that finally precipitated the changes set out by Enoch Powell in 1961. Mid Staffs and other scandals may be the galvanising force needed to finally shock the system into changing. Mike Farrar made a compelling case that instead of blaming nurses and others for the failure to care for the needs of frail older people with dementia in our hospitals, we need to recognise that it is the system and organisational context that is at fault. The model of care in acute hospitals is not fit for now, never mind the future. Nothing less than radical change will do.

The King’s Fund will be playing its part in shaping the vision for the future of care as we launch a programme of activities in the autumn with our own case for change. We hope you will engage with us in shaping a vision for the future of health and care in England.