WELLARDS CONFERENCE
NHE went along to the Wellards Conference at the Royal College of Physicians on November 9 to hear from experts inside and outside the NHS on where the health service is now – and where it is going. Adam Hewitt reports.
Some of the most experienced voices in healthcare across all the major sectors addressed an audience of pharmaceutical and medical technology workers keen to get a handle on the direction of travel in the NHS, the impact clini- cal commissioning will have, how QIPP is affecting procurement and the hospitals as cost centres vs profit centres debate.
The speakers were King’s Fund chief executive Chris Ham; De- partment of Health director for improvement and efficiency (and thus QIPP) Jim Easton; NHS Al- liance chair Dr Michael Dixon; Dr Gordon Coutts, chief executive of Colchester NHS Foundation Trust Hospital; Cllr David Rogers from the LGA and NHS Future Forum; and the HFMA’s Chris Calkin, fi- nance director at University Hos- pital of North Staffs NHS Trust.
Despite some disagreements, the
speakers were as one on most of the big issues.
Professor Ham told the attendees that many of the efficiency sav- ings and productivity gains to be found in the NHS lie in the ‘inter- faces’ between organisations and in integrating care.
But everyone knows at the mo- ment that the incentive structure is not set up to do this.
He said the future for the NHS will more and more lie with deal- ing with older patients with, say, COPD and dementia and other co-morbidities. Already, two- thirds of hospital beds are ac- counted for by people admitted as emergencies, often with an acute
illness exacerbating an underlying chronic condition.
Although his proposition was dis- puted by other speakers, Profes- sor Ham says that hospitals need to be regarded as cost centres – not profit centres, as they have been recently. Investment should be shifted away from the acute sector and towards primary care and care closer to home, in the community.
He said: “[Activity-based funding of hospital trusts] can’t continue. That was fine when the problem was about improving access, and people were coming in on a planned basis, and budgets were growing by 7% a year, but when budgets aren’t growing, and where the focus is shifting to the admission of people with chronic conditions, you need a different set of payment mechanisms to reward what needs to be done:
hospitals should be cost centres, not profit centres.”
He said the NHS is “fighting the last war” and that the US, for all the criticisms of its healthcare system, did have examples of how integration can be done.
But whether it can be emulated over here at the same time as the efficiency challenge and the struc- tural reforms was difficult, he said – there are certainly plenty of risks in the transition to the ‘new’ NHS, and one of the less-discussed is- sues is whether clinical commis- sioning groups are going to have the drive to get involved in the complex issue of reconfiguring care – which in blunt terms often means closing hospitals or at least units.
Innovation has been problematic in the NHS, more than one of the speakers noted, because despite attempts to incentivise it by copy- ing the private sector, the val- ues and reward-models are built around managers avoiding crises and not messing things up – and thus to be risk-averse. But the ‘Nicholson challenge’ of saving £20bn via QIPP is going to need a shake-up of that value system to one much more open to radical change and new ideas.
Helping to make those changes is Jim Easton, who insisted that QIPP is about service redesign, not about cost savings at the ex- pense of care quality.
He explained: There are a group of people, and they are the minority, who are completely switched on to QIPP: using service redesign to add value and take out costs. But there’s another group of peo- ple, also in the minority are doing
12 | national health executive Sep/Oct 11
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