Purpose, realism and confidence
He also talked of the need to be realistic and not give people false hope. “With the necessary management cost savings, some people are going to lose their jobs and we shouldn’t give people false hope.”
But he was clear that NHS leaders should have confidence: “We have done great things before and we can do so again.”
Ambitious programme
He described the different landscape associated with working with a coalition Government and its ambitious five-year programme.
He said: “It’s not the same as working with one political party. They’re openly discussing how it’s all going to work and are genuinely trying to work together.”
Talking about the plans for GP consortia, he was clear that NHS leaders will have to change the way they think. He said: “The natural response is to think about how the governance and mechanics will work. But I think to do that misses the point. We need to ask what the opportunities are, work with GPs and use what we’ve learned from World Class Commissioning.”
Support NHS staff
He said the most important lesson from change in the past that hasn’t worked is keeping sight of the purpose of what we’re trying to do. And he said this is the time for NHS leaders to take up the challenge, adding “Our staff need the support and oxygen that only we as leaders can provide.”
He acknowledged the anxiety about the changes and promised to do everything he can to “give our people the respect they deserve” and to give staff a greater say to make them feel empowered.
Foundation trusts
He sees that the QIPP process will continue to be critical and reiterated Andrew Lansley’s plea to trusts that are not yet foundation trusts (FTs) to put the effort in to become FTs.
Questions
Responding to questions from the floor, he agreed that relationships with local government are critical and that the scope of NHS services will need to increase to cater for social services clients who are also patients, adding: “We need fluidity here and the system will need to be more flexible.”
He wouldn’t be pressed on timings for the transition to the new system but said the white paper will set out what he thinks is achievable as a framework. He reiterated there is much we can do now without waiting for the white paper and recognised that the necessary contract negotiations with the British Medical Association will take time.
When asked about anxiety from the Treasury, he acknowledged concerns about cost and accountability and said that he too would be working to get the details right. He recognised the efforts of NHS managers in turning around the financial deficit in 2004/05 and stated his determination not to return to that situation again.
His speech ended with a rousing reminder of the purpose behind what we all do, quoting from the NHS Constitution: “The NHS belongs to the people. It's there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives.”
NHS Confederation reaction
Acting chief executive Nigel Edwards said: "Sir David Nicholson’s speech to NHS Confederation conference today was a typically trenchant call for NHS leaders to respond positively to the changes planned for the health service.
"His message that the people responsible for running the NHS need to focus on delivering for patients rather than agonising about organisational structures is one which will resonate beyond the conference centre. It is a valuable reminder of the values that should underpin everything we do in the health service.
“The months and years to come will certainly have their challenges; the key will be in making sure everything NHS staff and leaders do helps improve the care we provide to patients and the support we give to their families.”
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