Mike Farrar sets out big NHS challenges for the year ahead

The head of the NHS Confederation has warned of a potential loss of confidence in the NHS unless political and healthcare leaders make a compelling case to the public for changes to the delivery of services.

Setting out the top issues for 2012 in a New Year’s message, Mike Farrar, the NHS Confederation’s chief executive, says the NHS must convince people to let go of the “outdated hospital-or-bust model of care”. It must shift resources into community-based services, early intervention and self care.

NHS leaders believe that at least 25 per cent of patients in hospital beds could be looked after by NHS staff at home, Mr Farrar says. Political and NHS leaders need to be “honest about the issues, bold about the solutions and decisive in taking action”.

They must offer the public a compelling vision of how services can be better after the changes. They must avoid the traps of focussing exclusively on the closure of some hospital services and failing to explain how the public would benefit overall.

The NHS is already trying to make £20bn worth of efficiencies by 2015 in order to cope with a flat budget and rising demand. But Mr Farrar says the economic backdrop suggests that the age of austerity will now go on even longer, making the task more urgent.

He says: “We have had a lot of talk about changing services but 2012 must be the year we convert talk into action. It feels like the focus is on everything but the thing that would make most difference.


“Hospitals play a vital role, but we do rely on them for some services that could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self care. There is a value-for-money argument for doing this, but it not just about money and the public need to be told that. This is about building an NHS for the future.


“Care would be better for frail patients who would have fewer crises, shorter hospital stays when they need them, and more time in the comfort and safety of their homes. There would be opportunities to improve safety through consolidation of specialist services. There would be major potential to deliver better value for money and keep the NHS on a sustainable footing. We all know that quality of care will fall victim to a financial crisis.”


Mr Farrar identifies four factors that would help bring about change:

• Strong political leadership – politicians have failed to support the NHS even when the case for change has been clear.
• Strong clinical leadership – the voice of clinicians will be more powerful than ever under the new system but they must not be set up to fail through lack of support.
• Changing how health services are paid for –perverse incentives often mean it may not make financial sense to provide care out of hospital even though this may be best for patients.
• Listening to the public - NHS must always listen and be prepared to change course when it is getting something wrong.

The task of shifting public and political opinion on change is one of five key challenges for the NHS that Mr Farrar identifies for 2012. The others are:

• Coping with unprecedented financial pressures - increasing efficiency and minimising rises in waiting times;
• Addressing concerns about the quality of care - in particular the dignity of care of older patients and the monitoring of safety;
• Implementing Government reforms to NHS structures - minimising distraction and loss of momentum;
• Resolving the long-term funding of social care - failure to tackle this issue will have a major impact on patients and NHS services.

Mr Farrar says: “The public is rightly concerned about the persistent reports of poor standards of dignity and the ability of the NHS to cope with the growing numbers of older patients and people with dementia. The Mid Staffordshire public inquiry will no doubt broaden the focus onto a wider set of quality issues and the safety of care in particular.

“Key to meeting these concerns will be staff engagement. We know that good staff engagement has a clear impact on patient satisfaction and the outcomes of care. By giving our people clear direction, good support and treating them fairly and supportively, the NHS can create a culture where dedicated staff give their best for patients.


“The NHS absolutely must rise to these challenges. Those doing the day job however face major pressures in trying to keep the NHS’s head above water. They will be trying to stop waiting times getting out of control. They will be focusing on making all the new structures work as a result of NHS reform. There is a real danger of distraction.


“We must not allow that to happen if we want 2012 to be a success.”

Source: NHS Confederation