Conference report: from the NHS Confederation in Manchester

The NHS Confederation, the organisation that represents NHS organisations, held its 2008 conference in Manchester from 18-20 June 2008.

With the 60th anniversary of the NHS and its Next Stage Review both imminent, keynote speakers looked back to the past and forward to the future. Further change is on the way: and that will have implications for healthcare information and IT. Lyn Whitfield reports.


The NHS Confederation held its annual conference in Manchester last week as the NHS prepared to celebrate its 60th anniversary and the government planned to publish its Next Stage Review.

Inevitably, this meant its keynote speakers were inclined to look both backwards and forwards; to stress the importance of the NHS over six decades, while hinting at how it would need to change in the future.

Although health secretary Alan Johnson told the conference that Parliamentary protocol meant he could not “raise the veil” on the review and could only “show a bit of leg” (and NHS chief executive David Nicholson said he was “not supposed to show that much”) some of its themes became clear over the week. “We are entering an information age, in which the whole population will have information about healthcare.”

One of these is a focus on quality and another a continued shift from care in hospitals and other institutions to care in the community and people’s homes. Both are likely to have implications for the use of information and so for IT.

Past and present

Whatever changes emerge from the Next Stage Review, speakers emphasised that the essential “values” of the NHS will be adhered to.

Mr Johnson said that it would continue to provide “serenity” for sick people and their families by remaining free at the point of delivery. Indeed, he said that since genetic profiling will soon develop and make insurance unaffordable for large numbers of people, the NHS “is an idea whose time has come.”

However, the health secretary also said that the NHS today is operating in a very different environment from the one in which it was founded back in 1948. So, although he promised there would be no mass reorganisation and no new, central targets, he said it would need to change to respond to new consumer demands and the increasing burden of chronic disease.

This, he indicated, would mean a new emphasis on quality, on shifting care from hospitals and other institutions to the community and even people’s homes, and to promoting health and “wellness.”

Measuring compassion

Mr Johnson said the new emphasis on quality would generate a demand for new information to measure it. One aspect of quality, he added, would be “compassion”, for which the NHS will be developing new “metrics” with nursing and other staff groups. “The data is going to start flowing over the next few years, so we are going to have to deal with it.”

Although the idea of trying to measure compassion has received some derision in the press, Mr Johnson said new measures would help to retain trust in the NHS. “It is important to get the little things right,” he said. “Failing to close the curtains during an examination, or to help people to eat at mealtimes, does not inspire confidence.”

Into the information age

The NHS’ chief executive picked up many of his political boss’ themes, saying the NHS was facing five “big challenges”: rising expectations; the impact of new drugs and other innovations; the increasing burden of “lifestyle” diseases; and the impact of new information systems on both patients and employees.

“We are entering an information age, in which the whole population will have information about healthcare,” said Mr Nicholson. “And we will have a more educated workforce, used to using [IT] skills [who will take them elsewhere] if we do not use them.”

Mr Nicholson said these factors would drive change in the NHS, so politicians and managers could only accelerate or slow but not stop it. However, he said that if they were to manage change, they would need to be clear about their values, objectives and methods.

In the years after the NHS Plan was published in 2000, Mr Nicholson admitted that policy makers and mangers had talked more about methods – policy tools such as choice, new providers and new payment mechanisms – than values. "...another theme of the Next Stage Review would be “personalisation” and that it was likely to promote choice, personal budgets and personal care plans for people with long-term conditions."

But he said this would change with the publication of an NHS constitution or statement of values to coincide with the 60th anniversary on 5 July. Meanwhile, he said that Lord Darzi’s Next Stage Review would give the NHS a chance to focus on health inequalities and improve primary care.

Mark Britnell, the NHS’ director general of commissioning, said improving access to and the quality of primary care, would be one of the first applications of the “world class commissioning” tools he has been developing for primary care trusts.

The consumer revolution

Mr Britnell and other keynote speakers also stressed there would be no going back on plans to create polyclinics (or what they invariably called “GP-led Health Centres”), despite opposition from some doctors.

In a few years, though, the creation of new centres for GP services may come to seem like a relatively minor change. Mr Britnell said another theme of the Next Stage Review would be “personalisation” and that it was likely to promote choice, personal budgets and personal care plans for people with long-term conditions.

Taking this a stage further, the NHS Confederation published a report sponsored by Microsoft that identified technologies to give people more control over their records, health and treatment as one of the most significant “disruptive innovations” facing the health service.

The report singles out the development of platforms such as Microsoft’s HealthVault for particular attention, and many people who made the trip to Manchester argued that they will help to create a new breed of “predatory consumer” in healthcare.

Mike Bainbridge, NHS Connecting for Health’s clinical architect, didn’t go quite that far. But he did tell a fringe session that the NHS had to be ready to accommodate patient-generated health records and information from personal medical devices.

Although he acknowledged that work would have to be done to verify who had generated the data and how trustworthy it was, he said: “The data is going to start flowing over the next few years, so we are going to have to deal with it.”

Facing the future

However, Mr Bainbridge argued that health and social care will need to adapt to another disruptive technology, tele-health and tele-care, even faster.

If they did not get services to deliver health and care monitoring and alert services into people’s communities and homes, he warned, the ageing population and rising burden of chronic disease would make services unsustainable within 40 years.

“We have to do this over the next five years if we are not to see the NHS go over the falls – the equivalent of Niagara Falls – with or without a barrel,” he said. “In ten years, things start to get very expensive on the current model. We are that close.”

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