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At the heart of change

NHS chief executive Sir Nigel Crisp praised chairs as the drivers of change but called on them not to release their grip on improved service delivery.

"You and your chief executives have led your organisations successfully through a demanding period - together your results are impressive and give us all real confidence for the future.

"Without good governance led by you, we will not continue to make the changes that patients and the public want to see.

"Together you have brought waiting down across the whole system, from GPs to A&E, to hospitals and back to the community.

"What makes your performance even more rewarding is to get behind the figures and look at people - at the real long-term improvements in outcomes and life chances for individuals and society at large.

"NHS chairs are pivotal in helping people give out their best - your motivation and goodwill towards the NHS is very high.

"That is why, in Governing the NHS, we have put chairs and their boards at the heart of the change programme. Without good governance led by you, we will not continue to make the changes that patients and the public want to see."

For the remainder of the financial year, Sir Nigel said the focus will be on: sustaining pace on delivery; effective winter management; using choice to raise awareness of patient involvement; new staff contracts; value for money and bureaucracy; and the IT programme.

He said that sustaining progress was crucial.

Cutting bureaucracy

Stripping out outmoded red tape and sharing more resources will be key jobs for chairs over the coming year.

Sir Nigel Crisp said: "Locally, I am looking for all 600-plus NHS organisations to tackle this on two fronts. First, to strip out outmoded bureaucratic steps for staff, patients and users - to exploit and redesign new IT and prescribing systems for example - to free up professional and administrative time and avoid the 'care paper chase'.

"Second, to reduce local overheads - by sharing more backroom support functions, by sharing management resources and by setting yourselves demanding challenges on reducing overheads."

Sir Nigel added that the Department of Health was undergoing the same exercise.

"I am committed to reducing the national overhead - as I am doing in re-orientating the work of my own department and reducing its size, by enforcing a tight gateway process and by working with other national bodies to streamline regulation and data collection.

"This is high profile - you and I need to account for this to the public - and explain what we are doing."

The challenge of GP recruitment

The challenge of recruiting more GPs into the NHS was raised by chairs at the conference.

One chair said the pressures under which GPs were working and the challenges PCTs face in replacing them was being underestimated by the department.

"It is a major challenge - many of us are not balking from it but I think we would be rash to underestimate just how great a challenge it is," he said.

Rural areas faced similar problems, another chair added.

A chairman from the north told the conference that his area was facing a 'double whammy' in terms of GP recruitment problems.

"There is already a very acute shortage of GPs and, on the other hand, we are dealing with acute disinvestment and a really high level of prevalence of health inequalities.

"We have tried, in collaboration with other PCTs in our area, to go as far afield as Spain - recently we were able to recruit about five.

"I don't want to deprive some of the developing countries of their GPs but I think simply to restrict recruitment to the EU countries is not going to be successful."

Responding, Sir Nigel Crisp highlighted the high number of GPs with a special interest - 30 per cent - at one Bradford PCT which was cutting hospital waiting lists dramatically.

"I think you just need to continue to look at how you can actually build the reputation among the GP community that the NHS is a good place to work and how you can put the support in to make that happen."

He said that chairs should learn from leaders of other successful organisations and services to see how they attract and retain quality staff.

But he also acknowledged that more could be done nationally, particularly in recruiting people from abroad.

Governing the NHS

Governing the NHS - a Guide for NHS Boards should be used to improve the quality of non-executives in the future

The guide, developed by the NHS Appointments Commission and the Department of Health, was drawn up taking account of the experience of chairs, non-executive directors and senior managers.

The aim is to reinforce the importance of good governance and strategic leadership at a time of major reform in the NHS. Commission chair Sir William Wells said the response to the guide had been very positive.

"It is a very important document - for the first time it sets out governance in the NHS and the inter-relationship between all the various organisations.

"It makes the role of non-executives much clearer. What I want to do, with your help, is to use that to improve the quality of non executives in the future - the role has changed very dramatically and is continuing to change," he said.

One chair said non-executives helped trusts maintain direction while guarding against complacency.

"It is about giving an input and being one of the catalysts to maintaining good performance," he said.

Governing the NHS - a Guide for NHS Boards is at:

• Governing the NHS

The last Non-Exec Bulletin contained a detailed report on the new guide and is available at:

• Non-exec bulletin

Winter challenges

Leadership opportunities

• NHS leaders (opens new window)

NHS Executive Search

• NHS Confederation publications (opens new window)

NHS Live 2004

Making a difference