Breakfast seminar

“A huge amount of the NHS is reliant on strong long-term relationships,” NHS Confederation Chief Executive Mike Farrar told delegates. Although the NHS was known as a labour-intensive organisation, with 65p out of every pound spent going on its workforce, the rest of that spend went to suppliers and partners.
 
With so many of the organisation’s decision makers coming from a strong public sector background, however, decisions could often be made “on values rather than value”, and those decision makers could also fail to appreciate the issues facing small and medium-sized organisations, such as cash flow. The NHS was “such a vast edifice”, he said, that it could be “divorced from what’s going on” in the rest of society.
 
“Health is a huge opportunity for investment – we know the order book is full, we know about the aging population, but the way we engage means that investment can often end up going overseas. We can’t afford to keep getting this wrong”. Failure to bring the different sectors together with a common purpose was “affecting us as a nation”, he told delegates.
 
The NHS would need to find improvements in the coming years even if the government continued to ring-fence its budget, he stressed. “Any other organisation faced with this would be consolidating and rapidly pulling in new technology. But as it is, even marginal changes become controversies in the press.”
 
The entire sector needed to reconfigure and reconstruct itself, he told the seminar. While the numbers of people going to hospital who didn’t need to be there continued to rise, what most people wanted was support to stay away from hospital. “We still have a medical model with a care adjunct, and that needs to be the other way around. We need to change the debate”.
 
One of the problems in doing so was political, he pointed out, with parties opting to take the short-term view and some politicians “creating windmills to tilt at, such as local service changes, rather than being courageous”. The public were more open-minded than politicians gave them credit for, he said, and while politicians needed to engage with them properly, the NHS itself also needed to do more. “We need to be more transparent about things like choices, costs and variations in quality. I think the public will come with us, but we’ve allowed the debate to move away from what really matters.”
 
One potential benefit of the current reforms was that doctors were generally trusted by the public, he said, and could help to lead the way. “If we can get the clinical commissioning groups to work with us on this then we can really unlock a potential in the public to support and champion change, that the politicians will then follow. But we’re not there yet.”
 
The opportunity to restructure and repattern services to save money and improve care existed, he stressed. “But all our money is being sucked in to firefighting on one side when it should be restructuring the other side.” Commissioners had funds that could be used but they needed to be bold, he told delegates. “We should be in a very attractive place for people to come onside, but not only are we having these values arguments and moving around the deckchairs, we’re also moving around the people in the deckchairs”, making it very difficult for essential long-term relationships to develop.
 
The value of a health service relationship came out over a period of time, he said. “The people who hang on in there will get their rewards, but you need to set your horizons long-term. We should be putting together a far greater public-private partnership, and we really don’t have any alternatives – the taxpayer certainly doesn’t have the money.” Effort now needed to be focused on getting “proper exemplar deals” off the ground, he said.
 
Getting NHS leaders to see “what it looks like on the other side of the fence” was vital, he told the seminar. “The opportunities are there, but senior managers need to embrace a new approach to commercial relationships.”