Website of the Department of Health

NHS Chief Executive Sir Nigel Crisp headed the list of high-profile speakers appearing at the QE2 Conference Centre in London on 6 October.

Key issues including the National Programme for IT, finance, foundation trusts and primary care commissioning were tackled through a series of presentations and Q&A sessions.

PM hails local NHS leaders' achievements

Prime minister Tony Blair sent a message of support and thanks to all chairs and non-execs for their tireless work in helping to transform the NHS.

In a short speech conveyed through NHS chief executive Sir Nigel Crisp, the prime minister said: 'We have overhauled and modernised the system and expanded and improved services and access to care and treatment.

'More treatment and care is now available closer to home and patient choice and the way the NHS works is being transformed.

'Premature deaths from cancer and heart disease are falling at a faster rate than any other European country.

'Your leadership, as chairs, has been pivotal in all of this.

'Going forward, our challenge is to reshape the NHS, building on The NHS Improvement Plan so that it is not just a national health service but is also a personalised service for every patient.

'Your determination and focus is critical in the drive for more choice for every patient - our objective is fairer, faster, better care for more people than ever before.'

• The NHS Improvement Plan : Putting people at the heart of public services

Transforming the NHS - together

NHS chief executive Sir Nigel Crisp called on local NHS leaders to seize the opportunity for delivering service changes on an unprecedented scale.

He spoke of the crucial importance of chairs in setting a clear direction for their organisations and inspiring frontline staff to strive for delivering better services.

'It is under your leadership and stewardship that the NHS has come a very long way in the last 12 months - from my visits around the country, I can sense that everyone has real optimism for the future,' said Sir Nigel.

Local NHS leaders' roles would also become even more pivotal as the NHS moved further into a new era of primary care commissioning, foundation hospitals and private sector partnerships.

'I know that the scale of the management challenge is immense and I know that some of our staff sometimes feel more 'done to' by the powers-that-be than supported.'

He urged chairs to concentrate on these key challenges:

* stay focused on delivery

* guard the reputation of the NHS

* tackle hospital cleanliness

* involve your communities in change

* use your boards for strategic reform

* avoid old battles and work across barriers

* champion race equality.

Chairs and non-executives should also access the support available through a range of national resources, including the NHS Modernisation Agency's 10 High Impact Changes for Service Improvement and Delivery document and the work being done through local NHS Live projects.

'I would urge you all, if you haven't already done so, to study the 10 high impact changes and see how you can lead changes within your organisations. As is so often the case, such concepts can be beguilingly simple to implement.

'As chairs, I know the critical role you have in listening to staff, in taking the mood of your organisations and in helping them both to focus and keep the wider perspective.

'Great chairs are often quietly effective - they are not often in the limelight but they are important in providing the context and the climate for organisations to succeed.

'We have the privilege of leading the NHS into a future where we can really deliver quality services, services where we can put the individual at the centre, learning to treat patients as customers.'

• 10 High Impact Changes for Service Improvement and Delivery (opens new window)

Copies may also be obtained by phoning 08701 555455 or by e-mail from

• doh@prolog.uk.com (opens new window)

Promoting race equality

More than 600 senior NHS leaders have responded to Sir Nigel Crisp's personal request for people to mentor black and minority ethnic (BME) NHS staff.

Earlier this year he underlined promoting race equality - both for staff and patients - as one of his key NHS priorities.

In doing so, he launched Leadership and Race Equality in the NHS, a 10-point plan to designed to maximise recruitment and development opportunities for staff from BME backgrounds and address the specific needs of BME patients or clients.

He told chairs: 'I am delighted to have the support in this of so many senior people across the service.

'Over 600 senior mentors have already come forward to support NHS staff from black and minority ethnic backgrounds.

'You can ensure that personalisation has real meaning to every patient - please join me in this vital work to make the NHS an organisation with an enviable record on race equality.'

Financing a redesigned NHS

Ensuring that local NHS finances are managed better and more effectively will need to become a greater priority for trust management teams.

Department of Health director of finance and investment Richard Douglas identified these issues which chairs and non-execs will need to pay increasingly closer attention to:

* delivering and maintaining financial balance

* payment by results (PbR)

* fair allocation of resources.

Good finance management in the NHS, he said, was achievable through three key methods - the use of corporate 'muscle' to deliver a better service model, better costing of policy initiatives - highlighted by local difficulties in implementing the new consultant contract - and getting incentives and structures right.

PbR aims to provide a transparent, rules-based system for paying trusts. It will reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions.

In the new financial climate, chairs and non-execs need to:

* make sustainable financial performance a priority

* challenge efficiencies

* use the new systems, tools and incentives to manage change

* focus on income, not costs.

'We have had years of exceptional growth. This will not continue indefinitely. We all must focus on making better use of the money we have,' added Mr Douglas.

IT innovation 'critical' to NHS success

The full potential of the NHS IT revolution will only be realised if local NHS leaders empower frontline staff to communicate its benefits to patients.

Projects like the Picture Archiving and Communications System (PACS) would bring immense benefits all round, said Trent Strategic Health Authority chair chief executive and National Programme for IT national director of service implementation Alan Burns.

'The National Programme for IT is not a discussion, not a target - it is a good thing. It is something that will solve, not create, problems at all levels,' he said.

It would involve everyone - from trust management teams to clinicians, receptionists and patients themselves.

Citing the example of PACS, he added: 'There will be fewer X-rays, fewer exposures to radiation and fewer radiologists with bad backs from having to carry records around.'

The onus was now on chairs and non-executives to examine:

* Who is leading local implementation?

* How often is it addressed at board level?

* What is the nature of those discussions?

* Do people and services get discussed?

Dr Patrick Lavery, chair of Northgate and Prudhoe NHS Trust, said his trust had already successfully engaged staff and patient representatives on how NPfIT's work would benefit all those involved.

Other IT-related issues raised included:

* the need for a CD to 'sell' the concept of IT to staff

* NPfIT concept 'too stodgy' - a larger network of implementation advisors would help

* lessons to learn from how universities adapted to IT developments 20 or 30 years ago.

• www.npfit.nhs.uk (opens new window)

Primary care - a new era

New arrangements for commissioning primary care services will play an increasingly central role in the modernisation of the NHS.

As an experienced former GP, Department of Health PCT advisor Barbara Hakin said she was fully aware of the needs of primary care clinicians and staff.

'We all have a role to play in making services more responsive to patients. We all know patients ought to be seen sooner, locally and much more conveniently to their needs.'

To make all this fit together, local expanded primary care services had to be fully integrated with all areas of NHS care. She broke down the service into four main areas:

* urgent care (including out-of-hours, NHS Walk-In Centres)

* long-term care (case management, integrated health and social care)

* planned care (minor surgery, diagnostics)

* health improvement services (obesity, sexual health).

'The efficiency of all organisations, but particularly PCTs, is not just about making the books balance, it is about involving and empowering frontline staff - without these we will never be as effective as we should.'

Foundation hospitals - a management vision

Chairs of NHS trusts considering applying for foundation status have been given a 'checklist' of actions to help assess their suitability.

Some 20 trusts have now achieved foundation status since the first wave was announced in April. A further 20 applications are currently being considered.

Bill Moyes, chairman of Monitor - the independent regulator of NHS foundation trusts - stressed that they would be free of central control and be able to set budgets. But they would also have to bear the risks of issues like insolvency.

Chairs' and non-executives' roles within the new organisations were 'very different', he added.

'I think your role is much closer to the role of non-executive directors in a private company. To challenge things constructively, to assess operational performance and, most of all, understand the risks.

'I think the key focus is to achieve the right mix of skills and experience within the non-executive team.'

He urged them to examine:

* Does the senior management team have a good mix of skills and experience?

* Is the trust run effectively? How do you know? Is information shared effectively?

* Non-executives must challenge their trust's effectiveness if they feel it is necessary

* How robust are financial controls?

* Is the risk management process effective?

* Are you making the most of your governors?

* Is the trust effectively managing local relationships?

Foundation trusts - issues raised

The first trusts to be given foundation status can help shape the system's future development.

That's the view of Bill Moyes, who was responding to questions posed by various chairs and non-executives.

Asked what the policy was both on applications from mental health trusts and linked applications, Mr Moyes said applications from across the board were welcomed but added a note of caution.

'We have a wide range of partnerships but make sure you understand the risks as partners. Your risk profile is only as risky as the most risky partner.'

And, responding to another query about the benefits of getting in early, he added: 'The great advantage of being among the first foundation trusts is that you can shape the system.'

Another chair asked how concerned the regulator would be if a prospective foundation trust was in danger of falling short of targets such as the four-hour A&E waiting time goal.

'We believe that reaching targets is part of their authorisation - therefore we will want to understand why they are not delivering,' responded Mr Moyes.

• NHS foundation trusts
• More on Monitor (opens new window)

Local NHS services 'palpably better', say chairs

A huge majority of NHS chairs and non-executives believe that services in their area have improved in the past year.

That was the message from the conference audience during a series of questions about key NHS issues on which they were asked to vote.

And nearly two-thirds of those questioned - nearly half of whom were representing primary care trusts - also believe the level of management in the NHS is just about right. The full questions and responses were:

Is the NHS in your area palpably better than a year ago?

Yes: 72% (up from 59% in October 2003)

No: 14%

Same: 14 (26)%

Are staff more fulfilled and is morale more positive than this time last year?

Yes: 38%

No: 39%

Has the NHS too much management?

Yes: 28%

No: 66%

Undecided: 6%

Is your priority consulting/representing or efficiency/effectiveness?

Consulting/representing: 11%

Efficiency/effectiveness: 89%

Who are you representing today?

PCT: 48%

Mental health/priority service trust: 11%

Ambulance trust: 5%

Acute trust: 24%

Arm's length body: 4%

SHA: 6%

Other: 7%

Preparing for an election

The likelihood of a general election campaign early next year signals a need for NHS chairs and non-executives to focus on procedures.

Sir William Wells, chair of the NHS Appointments Commission, highlighted four particular issues which all chairs and non-executives should start thinking about.

They are:

1 - Business as usual

Ensuring that duties and responsibilities are not compromised by the distraction of an election campaign.

2 - Plan ahead

While remembering the above, you should also look ahead and try to anticipate any particular areas of work that could seriously impact on your organisation. For example, if possible you should consider rescheduling any local consultations planned.

3 - All candidates are equal

Remember that once any election campaign starts, everyone is equal so be careful not to extend any privileges to any particular candidate or be seen to.

4 - No party politics

As far as chairs and non-execs are concerned individually, they should not align themselves with any political party - double check everything sent out in your name.