Politicians need to be open with public about financial constraints of NHS, says its head

Politicians need to tell the public the truth about the real scope and effects of the changes that the NHS needs to make to become more efficient and effective while living within its means, the head of the NHS, David Nicholson, has said.

Nicholson, who is also chief executive of the nascent NHS Commissioning Board, which will have a key role in the new look NHS, was speaking to delegates at the annual NHS Confederation conference in Manchester on 21 June.

He referred to a speech delivered in 1962 by the then health secretary, Enoch Powell, which became known as the “water tower speech”—an allusion to the forbidding architecture of the Victorian mental asylums—and from which Stephen Dorrell, chairman of the parliamentary health select committee, had quoted extensively in his conference speech the previous day.

Powell had insisted that “radical service change” was required in mental health and advocated halving the number of inpatient beds and closing many asylums, said Nicholson, describing this as “really groundbreaking” at the time.

“And in lots of ways, it’s the sort of speech we need our national politicians to make at the moment,” he declared, drawing parallels between the two eras. “In a sense it’s being honest with the public about the nature and scale of change required in order to live in a world where we want to get great outcomes for our patients and universally available but within the resources that we have.”

Crucial to that change was a fundamental shift in thinking about the model of care and “a move away from the default position of getting someone into a hospital bed,” he said. “It’s difficult, [it’s] problematic, and we’ve known this for a long time, but I would argue that the financial position gives us the burning platform to absolutely get this right,” he said.

The NHS Confederation’s chief executive, Mike Farrar, had also emphasised the importance of being frank with the public in his speech opening the conference.

The latest indications were that the public had concerns and “confidence issues” about what was happening in the NHS, he said, but it was “absolutely essential” that the required changes enjoyed public support.

“We do need to tackle the thorny issue of acute hospital care, and we do need to talk to the public [and help them] understand that with centres of excellence, and perhaps in fewer sites than we have now, we can improve their outcomes,” he emphasised.

But politicians couldn’t always be relied on to spread the word, because they were “more interested in their electorate’s health than the health of the population,” he suggested.

“Even when the case for change has been made and accepted, [the politicians say:] ‘I understand the case for change, but I am going to be at the front of the march,’” he said, adding that NHS leaders needed to help them to “get out there and be courageous . . . and inform the public about what we need to do.”

But the NHS had itself been guilty of talking in terms that few people understood, he said. Instead of talking about “reconfiguration” and “integration,” it needed to use personal stories that people could relate to, he suggested.

Malcolm Grant, chairman of the NHS Commissioning Board, which will begin to authorise clinical commissioning groups in October, was also keen to present the fledgling body as open and eager to “engage in a completely different way.”

Meetings would be held in public, at venues across the country, and web streamed, he told delegates. “The top-down approach is dead,” he insisted. “The role of the commissioning board is enabling, facilitating, and supporting those with whom it works,” he said, adding: “It’s not our role to tell [clinical commissioning groups] what to do.”

The board’s draft mandate, which will govern the relationship between it and commissioning groups, will be published next month.