Representing estates and facilities professionals operating within the  



Hard facts: hard choices, says NHS Confederation Chair

Speaking at the opening of Confed18 this morning (June 13), NHS Confederation Chair, Stephen Dorrell said now is the time to move from merely celebrating the idea of the NHS and the achievements of the last 70 years and rise to the challenge of the future. This involves making and committing to those difficult decisions that turn an aspiration into a reality rather than “so much hot air.”


His comments are not aimed merely at politicians but at everyone who works within the health and care system. Nor are the challenges merely of a financial nature; Dorrell laid down the challenge of money, structure and working methods as the theme of the conference.



Earlier this year the NHS Confederation joined with the Health Foundation and the Institute for Fiscal Studies to sponsor their report on funding of health and social care between now and the 2030s. Dorrell explains: “Every person in this hall is familiar with the resource pressures facing the NHS and social care. It could hardly be otherwise. Those pressures shape the daily experience of those who work in the sector.


“What is more difficult is to stand back from day to day reality and understand long term trends. That is question which this report addressed.” 


The report also took a view of both health and social care as being intrinsically linked.


“This report acknowledges what we all know – that it makes no sense to look at trends in the NHS separately from trends in social care. Both sectors serve the same communities, and failure in either leads to demand pressures in the other. 


“More importantly, failure of the NHS and social care to work with each other and the rest of local public services doesn’t just lead to distorted demand patterns; it leads to worse outcomes and damaged lives. It violates the principles of universal healthcare of which we claim to be the guardians. 


“So this report looks at trends in health and social care together and it draws two stark conclusions. First - looking backwards, if allowance is made for the effect of the growing elderly population, it concludes that real per capita spending on health and social care services has not risen since 2010. Not the conclusion of a lobby group, or of a party politician, but the evidence gathered by two of our leading independent commentators on public services and public finance. Small wonder our services feel themselves to be under pressure.  


“But that provides the background to the second and most important conclusion I want to highlight from the report. If we are to deliver universal healthcare which meets the needs of our changing population, the authors conclude that there needs to be a commitment to increase taxpayer resources available to both health and social care services at the rate of 4% per annum.


Not 4% for the NHS and a squeeze local government – or a special fund to ease the pressures on social care. But 4% per annum for the NHS and 4% per annum for social care, year on year, between now and 2030.”


Structure & Working Methods 

“When we speak of challenges it is always easier to focus on the challenges which face others - particularly the politicians – rather than address the challenges we face ourselves. 


“One of the biggest of those challenges which faces every generation of NHS management is the need to ensure that our services are flexible and respond quickly to the changing needs of the communities they serve.


“We are all familiar with the problem. Communities, both inside and outside the NHS, grow used to established ways of working. We make the mistake of thinking that the familiar institutions are the essence of the NHS – we attach our loyalty to the institutions rather than to the values they were intended to deliver. 


“Good management cherishes the values – but ensures that that the structures change to allow them to be better delivered. That is what lies behind the development of new structures for accountable and integrated care. 


“Heaven knows we have talked about it for long enough. 


“We all know that the individual patient too often experiences our services as a series of disconnected episodes, rather than as a single joined up service. 

It may have been unavoidable in the days of black and white television and fax machines. But there is no excuse for it in the era of digital exchange and artificial intelligence. 


“We sometimes think our task is to introduce new technology to support service delivery. But that is wrong; it is much more fundamental than that. Our task is constantly to reinvent our services to use the full range of resources available to us to meet the needs of our citizens.


“That requires new methods of working within the NHS, and it requires new relationships with other partners in delivering joined up public services to local communities.”


NHS Confederation is supporting the process of moving to integrated and accountable care, working with other organisations, such as the Local Government Association. “Failure to implement new working methods across traditional institutional boundaries undermines the effectiveness of our services – and it undermines our commitment to the very principles of universal healthcare,” asserts Dorrell.


“The foundation of the NHS was a commitment to an untested idea; the best way to celebrate its 70th anniversary is to commit, once again, in the vanguard of testing new versions of best practice.” 


Power of people

It is the people that work in the NHS that really have the power to make a difference to the lives of others and Dorrell concluded by recognising the dedication and professionalism of the NHS workforce and acknowledging that the responsibility for facing the current challenges of the NHS rests on the shoulders of this group of people. 


“My challenge at the beginning of this conference is simple. We shall discuss money and structures and working methods. But it is all so much hot air if we don’t connect the discussion with what goes on in the surgery, the things that make a difference to the nurse’s life. 


“We are all part of the team. We share responsibility for its successes and for its failures. But it is the dedicated professional people who deliver our services on whom our fellow citizens rely. It is our task and our privilege to help them make a difference.”