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NHS ‘not delivering’ on service change, says Nicholson

The chief executive of the NHS has urged politicians to support GPs in making the case to the public for reconfigurations of services that could extend as far as closing hospitals, as he warned that the NHS was not delivering on service change.

In a keynote speech to the NHS Confederation conference in Manchester last week, Sir David Nicholson said that although the NHS had reached its target with QIPP savings of £5.8bn this year, this had mainly been achieved by efficiency savings.

He warned the NHS had not got to grips with the pressing need to reconfigure services, but said politicians had to do more to support managers and clinicians in making the case to the public.

His warning was echoed by NHS Confederation chief executive Mike Farrar, but health secretary Andrew Lansley struck a different chord, saying it was GPs and managers who should lead in explaining the rationale behind difficult changes to services to the public.

Sir David said it would be difficult to win hearts and minds without political leadership, and warned that a failure to grasp the scale of change needed would result in crude and ultimately ineffective efficiency measures being made.

He told delegates: 'We made £5.8bn in QIPP savings this year. Sometimes we've done it well, sometimes not so well. The issue we are not delivering on is the service change. If we don't do it then the emphasis goes to efficiency savings is where the danger lies.

'After a slow start, politicians are starting to respond. But I do think politicians at all levels need to be straightforward in [explaining] the radical change. We'll do our best to do it in the system but without political leadership, it is quite difficult to have that debate with the public.'

In his keynote speech, Mr Lansley said that as long as service changes passed his four key tests; demonstrating clear clinical benefits, representing the views of commissioners, reflecting the views of the public, and representing the needs and wants of patients themselves, then they should be supported by politicians.

But he added: 'Politicians should not be telling the NHS or the public what the best shape of their local services should be.'

In a panel debate at the conference, Stephen Dorrell, chair of the House of Commons Health Committee, said that although it was not politicians' place to dictate, it was their responsibility to explain where the public's taxes were being spent.

Mr Dorrell said: 'You have to make the case for change. It's certainly not the role of politicians to tell the health service how to do this...but it absolutely is part of the of role of politicians to play their part in explaining that case for change.'

Ruth Carnall, chief executive of NHS London, told the debate: 'Bottom-up can be good, but not if it results in an inability to get things done. Difficult decisions need leadership.'

Mike Farrar, chief executive of the NHS Confederation, told the conference that the NHS 'desperately needs' public support for planned change to services, but said politicians had consistently failed to 'put the long-term interests of their population's health above their short-term electoral interests.'

Dr Johnny Marshall, a GP in Wendover, Bucks, and interim project manager of NHS Clinical Commissioners, said it was crucial that every part of the system played their part in communicating 'the story'.

He said: ‘They will need to work together - as some changes may be across more than one CCG - with local authorities, the NHS Commissioning Board and politicians. Even if it's just without one of them, this may not work.'

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