Government's NHS reforms could be a 'bloody awful train crash', angry PCT chief warns

By Gareth Iacobucci

The Government's NHS overhaul risks becoming a ‘bloody awful train crash', with PCTs too consumed with reorganisation to tackle the daunting efficiency challenges that lie ahead, a senior NHS manager has warned.

Robert Creighton, chief executive of NHS Ealing, who has also recently taken charge of NHS Hounslow and NHS Hillingdon, said today that the turmoil of reform was inevitably diverting trusts from their task of tackling the proposed £20bn of efficiency savings set out by NHS chief executive Sir David Nicholson. (Click here to listen to what he had to say.)

Speaking at a King's Fund breakfast meeting this morning, Mr Creighton also hit out at the Government for its treatment of NHS managers, and said the NHS was ‘at risk of blowing it'.

‘This could be a bloody awful train crash. It could collapse. All of us are looking inwards,' he said.

‘I've got to completely clean out the team and make a whole series of new appointments. I spent 13 hours yesterday interviewing yesterday, I'm spending another six hours today, eight hours tomorrow. In all that time, I am not spending a moment thinking about patient care or money. It will be very difficult to keep everybody focused in the task in hand.'

'This must be working together, but we are at risk of blowing it. Sometimes I feel I'm only doing what I'm doing because of a sense of public duty. In two years time, I will probably be out of a job.'

'The Government is saying that everything I have done for the past eight years has been bad or should be destroyed. Where's the sense of that?'

His impassioned warning came after Conservative health select committee chair and former health secretary Stephen Dorrell, also speaking at the debate, acknowledged that the £20 billion efficiency savings, dubbed ‘the Nicholson challenge', were the most pressing issue facing the health service.

‘There is no resistance on my part to the ideas in the white paper,' he said. ‘What is important is to set them in the context of the time that we're in. That will shape the way in which these ideas are carried out in practice.'

‘The key issue facing the health service over the next four years is how to deliver the Nicholson challenge. There is no precedent in the history of the health service for delivering 4% efficiency gain in a single year. There's no precedent anywhere in the world for delivering it four years running.'

Mr Dorrell also called on the Royal Colleges to show greater leadership in driving the changes forward, and told delegates that it was essential for the profession to take a lead in addressing unwanted variation in primary care.

‘With freedom must come a responsibility,' he said. ‘The professions must own the process of challenging professional delivery of service.'

‘If the Royal Colleges are to justify their status as leaders and specialists in their field, what are they doing to drive quality and efficiency into the delivery of healthcare?'

RCGP chair Dr Clare Gerada, also speaking at the event, agreed with Mr Dorrell about ramping up clinical leadership, but warned that addressing variation should not lead to GPs being made scapegoats.

Dr Gerada said: ‘The colleges do have to do better. I agree with you on that. We have to re-energise the profession. We've been sitting back.'

‘[But] I have concern about blaming this on a few GPs who have been isolated for years. There clearly is variation, but I would look at the causes. [GPs] often work in deprived areas, isolated by their profession. I would rather work with them then blame them.'

Hear what Mr Creighton had to say immediately after warning that the Government's NHS overhaul risks becoming a 'bloody awful train crash'.

Attend the Essential Commissioning Skills seminar on 15 February (London) and 03 March (Manchester) to gain advice and guidance to adapt to change and meet the challenges ahead.
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