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David Nicholson, Chief Executive, DH & NHS, UK

by Lloyd Davis

whcc europe 2008 013Let’s talk about systems - This is the 60th anniversary of the NHS in England- it is not just an organisation, it is a national social movement that is ingrained in our society and change is extremely fraught. The issue of whether it’s the time to retire or renew is one that we’re focusing on a great deal.

18 months ago we were in the third year of running a deficit and there’s nothing like that situation to erode confidence in staff and the public. But now this has been sorted out and this year we’ll deliver a surplus of £1.5bn and expect to do the same next year. It gives us enormous self-control and freedom to take things forward. Those things that we want to do, we are now able to invest in.

The second issue is that of access - we are not quite world-class but moving in that direction. A colleague of mine remembers 10 years ago when he got a letter from a local man who had been waiting 14 years for a cataract operation saying that he felt too old to have the operation, but could he leave his place on the waiting list to his 60 year old son! Now 70-80% of patients are seen within 18 weeks with an average of 6-7 weeks overall.

And finally the issue of infections - we’ve reduced the rate of MRSA by 46% over the last 2 years, but we’ve still got a lot to do.

So we think we’re in a reasonable position but it’s only a platform for what we can do in the future. Key to this is seeing what we do as a system. We’re about half way through a journey to decentralisation. We started by building capacity in 1997 - we had a massive expansion, driving change by big top-down national targets. That’s fine, but it only delivers so much change. Then we moved on to delivering reform, bringing more of a mix to supply and new organisational models. And the next stage in the last year or so is how do you drive systemic change to bring about services based on the needs of patients and treating patients as partners - a drive towards personalisation.

Change is always complex, but this is what we’ve learned, there’s a limited number of things you can do top-down. We need to be radically devolving power to clinical teams so that people can work together on the ground and we need to engage clinicians in this process.

We’re now much better equipped but we also need leadership and IT, but most important is how we engage with patients.

So we’ll be delivering more choice, bringing more private providers into primary care and a lot of this comes out of our work with patients and staff. Another thing they want is integrated care - primary care and specialist care connected in the same building and with common IT infrastructure. We increasingly see the system needing to predict and prevent. With better information management we have much better ways of managing risk and putting into place individual strategies for patient’s health care.

So I think we’ve a great platform for the future and we’re clear about the future we want and we have an IT programme that will help us to make a leap forward.

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