Mersey beat: live from the NHS Confederation conference

The theme of this year’s NHS Confederation conference was money; and how to cope with less of it. Lyn Whitfield reports.

The NHS has 18 months until its financial settlement with the Treasury runs out. And after that, things are going to get tough.

Just how tough was spelled out in a paper by NHS Confederation policy director Nigel Edwards on the eve of the management organisation’s annual conference in Liverpool.

It warned that the health service will face “unprecedentedly difficult” times in the five years from 2010-11 and that it “will not survive the impending squeeze unchanged.”

Most of the rest of the conference focused on how it will change. Speaker after speaker begged managers and staff not to let waiting lists grow or to cut back on maintenance, cleaning and training.

Instead, they urged them to co-operate with other organisations, find new ways of doing things, maintain quality and find new ways of engaging with staff and patients – all of which could depend on IT.

“The worst thing we could do would be to hide in our bunkers and stop driving reform,” NHS chief executive David Nicholson told the conference. “Now is the time to be innovative and to adopt the well-evidenced things we should all be doing.”

Money’s too tight to mention

In the Budget, Chancellor Alastair Darling’s predicted that government spending will grow by 0.7 per cent over the next comprehensive spending review period (the five financial years that will start in 2010-11). 

However, the Confederation paper argues that most of this money will be soaked up by debt and benefit payments. If this happens, other government departments are likely to see their spending fall by 2.3 per cent overall.

In response, shadow health secretary Andrew Lansley told Radio 4’s Today programme that a future Conservative government would protect NHS spending. However, he admitted this would mean that other departments would be hit even harder – triggering a political row about “cuts.”

Even if the health service escapes the worst, the Confederation paper says that increased demand (caused by the recession and the aging population) plus higher costs (from drugs, legal fees and pay reforms) will leave it facing a real-terms shortfall.

It calculates that this could be as high as £15 billion over five years; or more if hard cash has to be released from the system in “efficiency savings”.

Innovate, don’t cut

The paper says this does not mean that Britain cannot afford the NHS – and warns that some popular ideas for raising money, such as charging for GP visits or hospital stays, would be unlikely to raise much cash.

It also says NHS leaders should not resort to the measures that were tried in the 1990s, when waiting lists grew to more than 18 months and huge building backlogs built up. This was also the message put across by most of the speakers at the event.

"Innovation, efficiency, productivity and prevention are what should drive the next stage in creating a people-centred NHS,” said new health secretary Andy Burnham, who argued that reducing medical errors, avoiding hospital acquired infections and keeping people fit would all save the NHS money.

“If the problem is to improve efficiency and quality and to engage patients and staff in how to do that, then that is what we should have done four years ago, but might not have done because of all the new money coming into the system,” said Mike Farrar, chief executive of NHS North West. So if this [crisis] is a catalyst for that, then it could be a good thing.”

If it is to be a good thing – and the NHS is to cope with the credit crunch while driving forward the quality agenda set out in Lord Darzi’s Next Stage Review - then technology will need to play and important supporting role.

In a debate on “how tough is it going to get”, Michael O’Higgins, chair of the financial watchdog the Audit Commission, held up telemedicine as a technology that could improve services while also saving money.

“There are technologies that are win-wins,” he added after the debate. “For example, online check-in is cheaper for airlines, but I use it because it is more convenient for me.

“There are places where the NHS is adopting this kind of thinking. We have flagged up some great work that is happening in Kent, where people are able to take their own blood pressure at home and send the results back to health service staff.”

A terribly long engagement

Away from the main stage, Microsoft had sponsored a series of sessions on engaging the public; both in the need for change and in taking charge of their own health and healthcare.

One of these discussed how personal budgets, which are already being used by councils to give older and disabled people more choice and control over the care that they receive, could transform the health service.

Jeff Jerome, national director for social care at the Association of Adult Social Services, said that although budgets were hard to calculate and explain, and that the market for them was still developing, they were not going to go away.

“The idea is to build services around people, instead of extending the welfare state model in which they have to use the services we build for them,” he said. “It is not clear that in the future people would accept that.”

Microsoft has been working with the consultancy Tribal to show how its Dynamics suite can be used for stakeholder and patient relationship management; enabling NHS organisations to engage more efficiently and creatively with the people who use their services.

This work was on show on its stand in the huge exhibition attached to the conference; as were many technologies to help staff work more effectively.

“David Nicholson was talking about productivity, and we have been demonstrating Microsoft Information Worker,” said Microsoft’s UK healthcare strategic marketing manager Mark Treleaven.

“That is something that the NHS already owns through its Enterprise Agreement with us, which can make a big difference to the productivity of individuals and organisations. We have also been showing how Unified Communications can improve productivity by helping staff to work together.

“This is commodity software. It doesn’t need to be developed at huge cost. The real issue is culture change: the NHS needs to adopt the new ways of working and to realise the benefit from that.”

Will IT happen?

If there was an unspoken fear at the conference, however, it was that the NHS will try to carry on much as it does now as the financial climate worsens, cutting back here and there to try and make the books balance.

Worryingly, in a show of hands, only 40% of those attending a “how bad is it going to get” debate thought that the NHS could make the savings it would need to make by innovating for efficiency and quality. Yet technology is available to help it do just that.