Public Opinion

The NHS Confederation annual conference, which starts tomorrow in Birmingham, gives senior managers and non-executives in the NHS a valuable opportunity to take a step back and discuss how we can improve patient services.

This annual event also gives me the opportunity to reflect on what has changed over the past year in the world of health. Looking back on last year's conference it seems extraordinary that, just a year ago, we hadn't even heard of Commissioning a patient-led NHS. This major structural reorganisation of the NHS has dominated the thoughts of senior managers and non-executives for nearly a year.

Unsurprisingly, such a major reorganisation tends to divert attention away from some of the important issues and, instead, leaves people worrying about their job and their future. Amazingly the NHS has become used to handling the repeated changes without breaking step. However, it is inevitable that establishing new NHS organisations creates anxiety for those that work in Primary Care Trusts.

As we move forward, there are a number of important challenges. One of the most important is how we ensure that the Boards which will lead the new organisations are helped to develop and flourish in the new system.

Every single board, and board member, must take responsibility and accountability for the decisions they make about the health of the population they serve and the development of local health. They must lead the transformation of an end of the 20th century healthcare system, into a system that is lean, effective and technologically adapted to the needs of the 21st century. A service that is focused on the type of responsive services that the baby boomer generation will wish to use for themselves and their families.

The lesson from the establishment of foundation trusts is that to deliver change boards need the freedom to lead and take responsibility. In a publicly funded system this must be supported by public assurance systems that reassure taxpayers that their money is being spent to best effect and that predicts problems and prevents them happening rather than blaming people after the event. This requires an effective regime to deal with organisational failure without allowing patient care to suffer.

This needs a new approach to governance. A performance framework that focuses on outcomes, instead of targets and inputs to allow organisations to develop their own priorities and processes and help members of NHS boards to assess the performance of their management teams and ensure that the right people are hired.

This requires a more sophisticated performance management system that aims to ensure success, recognises that communities have differing needs and respects the local solutions planned and executed by management and clinicians.

Non-executive directors and those that work in the NHS share a strong public service ethos. It is that ethos that has made the NHS great over the past sixty years. But having that public service ethos still requires boards to exercise strict financial control and take the difficult decisions that are required of them. Every pound spent inefficiently is a pound that cannot be used to benefit another patient. Within the NHS, inefficiency is a moral imperative not an optional extra.

If boards manage to deliver in the new organisations that make up the modern NHS, and I am quite sure they will, they will deserve political support from all parties and an end to the situation where the NHS is treated as a political football where the highest ever patient satisfaction rates for the service (92% finding their treatment good, very good or excellent) are not even reported and certainly not praised!

Dr Gill Morgan DBE
Chief Executive
NHS Confederation

The Times - 13th June, 2006