Annual gathering of NHS managers’ eyes Government reform with suspicion and a gathering gloom

Isabella Sharp, Senior Associate, APCO London

The sun was shining in Liverpool for the NHS Confederation Conference last week but inside the conference centre clouds gathered as NHS managers congregated to review the issues of the day. Dark mutterings of discontent could be heard in the corridors and seminars about the prospects of managing cost and efficiencies and in particular the removal of commissioning from Primary Care Trusts, the Confederation’s main constituency, to GPs – regarded by some as the biggest fly in the ointment of efficient and cost effective distribution of care.

Attention focussed on the arrival of the new Secretary of State for Health Andrew Lansley MP, the purveyor of the unwelcome reform and shortly of a controversial strategic White Paper which is to set out the transferral of some £60- 80 billion pounds to GPs control and said by one ‘unnamed’ yet ‘senior’ Department of Health source to herald the end of the age of PCT autonomy. Besides being a surprise to many commentators, who believed that the freedom given to PCTs under the Labour Government would be continued or even extended under the Coalition, the policy raises as many questions as it answers with details of the practicalities and process of reform remaining unclear. In the absence of clear information, an air of panic prevailed as delegates attending discussions expressed doubt that a cooperative relationship between primary and acute care could be continued and asked whether they would be wise to jump ship from PCTs before it was too late.

The press presence at this year’s conference was unusually high for what was otherwise agreed to be a relatively low key event and it promised to be an intriguing show-down as Andrew Lansley faced a sceptical crowd. Mr Lansley had made an uncertain visit last year shortly after deviating from Conservative Party policy on Departmental spending and someone was heard to remark that he might bring a bodyguard and leave his car running for this year’s speech – given the likely hostility of his audience.

In the end, Mr Lansley’s speech was deemed by many to be underwhelming and uninformative. He was clearly keen to win over the delegates, who refrained from heckling but made their feelings clear by grumbling to themselves and roundly applauding those questioners who expressed their doubt about the direction and feasibility of his plans.

No one left the conference much clearer on the implications for PCTs or the wider NHS although we were soon greeted with the news that the Treasury are reluctant to give Lansley the GP money after all – which did not surprise the assembled health commentators and gifted the Opposition health spokesman, and former darling of the NHS Confederation, Andy Burnham with a wonderful opportunity to pitch in and help boost his profile ahead of the forthcoming Labour leadership election.

Overall, however, the Treasury’s decision didn’t make the delegates much happier as, whatever the outcome of the White Paper, they know they will face competing demands to cut costs whilst remaining flexible enough to accommodate a new system which may threaten their very existence. It is clear that Andrew Lansley already faces a battle to keep the NHS workforce onside, from executive level through to the grass roots, and the success of any reforms depends on their cooperation and agreement. In the end, his more detailed proposals may not meet with as much opposition as he faces now and there are many elements – GP consortia for example – who will view it as an interesting opportunity. But for now, in the shadow of a Budget of heavy cuts, it is the lack of information and the fear of being thrust into ill-thought out and articulated reform that is as much a factor in the anger of NHS managers as any.