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How planning will help the NHS to be stronger after the recession

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Steve Barnett on why plans must be put in place to deal with the financial challenges facing the NHS

This year’s annual NHS Confederation conference was held against a backdrop of political debates involving cuts to public spending and those areas most likely to be affected in years to come.

Indeed, on the first day we witnessed our report on the financial implications of the downturn for the NHS spark a debate during Prime Minister’s Questions, with Gordon Brown and David Cameron contesting what impact the continued real-terms growth to NHS expenditure would have on other public services.

Two reports launched at our conference, Dealing with the Downturn, and Commissioning in a Cold Climate, outlined the challenges the NHS in England faces after 2011. Many speakers considered the issues that lay ahead for the health service and its patients. An increasingly ageing population and improved survival and fertility, teamed with the negative effects of a recession - ranging from a rise in mental health conditions to dependency on alcohol - has already put pressure on budgets.
But there is a growing awareness among NHS managers that the service will look different once the financial climate has recovered. Now is the time to plan what changes will be necessary.

The overriding messages from the three days of our conference were of realisation and preparation - accepting that there are tough times ahead and having the vision and the determination to plan. The language of strong local leadership was repeated by many of our speakers, in particular the need to engage clinicians and the public in achieving the scale of change required.
In his plenary speech, NHS chief executive David Nicholson said leaders should not fool themselves that the times ahead would not be ‘extraordinarily tough’ but advised against panic - reforms can and will have to be made. Now, he said, is the time to adopt new ways in thinking and practice.

‘The NHS cannot afford to return to slash and burn short-term savings that unduly penalise the efficient and leave the inefficient with untapped savings’

Indeed, the years ahead will require brave decisions to ensure the founding principles of the NHS are not put at risk. Having the knowledge of what has not worked in the past and using that as a template to manage efficiencies and value without jeopardising quality is essential.

What the NHS cannot afford to do is to return to lengthy waiting lists after trusts in England have worked hard to move patients through the system without unnecessary delays. It cannot return to slash and burn short-term savings that unduly penalise the efficient and leave the inefficient with untapped savings. But above all, the NHS cannot forsake or reduce the quality of care it provides to its patients.

Adopting innovative, evidence-based practices and encouraging a culture of curiosity will prompt a redesign of services and ideally more streamlined and improved care pathways. Constrained budgets, while challenging, should be considered an opportunity to create and improve services that may not be producing best results.

Speaking at our conference, health secretary Andy Burnham pointed out the link between efficiency and high-quality services - things go wrong when services and treatments become expensive, faulty and bloated. Prevention was a word repeatedly emphasised in his speech - investing in and promoting better health now to drive down costs for the future.

Shadow health secretary Andrew Lansley made a similar point in his speech, emphasising the need for efficiency and excellence in the service. Leading the health service through the coming years will require freedom to deliver results and services, he said.

Reducing hospitalisation of patients and moving more care closer to home in community settings is already under way and has proved beneficial to the service and its patients. As pointed out in Commissioning in a Cold Climate, using community services more wisely can drive down demand for more intensive and costly services that can often require lengthy hospital stays. A rigorous assessment to decide whether other services are still providing value for both users and providers will be essential.
The engagement of senior clinical staff will be vital in meeting the challenge of maintaining quality and redesigning clinical services during a recession. Strong evidence exists to show that organisations with clinicians engaged in the leadership of trusts deliver higher-quality care and are able to respond to change more effectively.

The NHS has the people, the ideas and the capacity to meet the challenge to its budget, but we should be under no illusions of the size of the task. We are at a stage where radical thinking needs to be incorporated into the everyday mindset of managers and clinicians and nimble footwork is essential to navigate the most cost-efficient pathway through the system without reducing the quality of care provided.

Our health service faces its greatest challenge and tough decisions need to be made now if it is going to navigate the choppy waters that lie ahead - but it has the people, the capacity and the ideas to do so and emerge leaner, fitter and stronger.

Steve Barnett is chief executive of the NHS Confederation

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