Delivering radical reform in public services was the government’s battle cry in last month’s white paper Working Together - Public Services on Your Side. Given the parlous state of the country’s finances, the message will be exactly the same from any future government.

The driving force for change is transferring more power into the hands of parents, pupils and patients, supported increasingly by personal budgets so services are tailored to local priorities and ultimately individual needs.

Those of us in foundation trusts are uniquely positioned to trailblaze in this area because of the opportunity we have to innovate in community development through our governors and members. Astonishingly, as former health secretary Alan Milburn highlighted recently, with 1.2 million members, the foundation trust movement has a greater membership than any of the major political parties in this country.

“History has many examples of managers delivering on affordability by cutting corners on quality”

My recent experience in handling a major public consultation about the configuration of hospitals casts some light on the implications on the next stage of reform. In any public consultation or engagement exercise there are some likely tensions which tend to play out between partners, professionals and local and national politicians. The job is to gain a consensus from all of them. It’s tough. Chaos theory is a good guide on how to do it.

Seriously though, success in this area means as a minimum you must have: a shared vision and support from your primary care trust, a cogent case for change, air cover from the strategic health authority, strong buy-in from consultant and other professional staff, external expert advice, a genuine desire to consult, effective communications and good external relationships.

Having a powerful cadre of public and patient governors who are firmly embedded in their local communities really helps, not only to promote the message but to also shape it from a position of understanding that we as health professionals alone could never achieve. 

Throughout our public consultation our governors led discussion sessions with foundation trust members in each of our five major localities. We provided them with media relations training so they felt comfortable in addressing public audiences. They had already been fully engaged in preparation for it - each took a role in the steering group and clinical service groups, which enabled them to understand the issues and - more importantly - bring a patient and service user perspective to temper more wayward elements of the technical and professional debate. 

Yet although this type of engagement and scrutiny was one of the main reasons behind our success in a contentious exercise, there is still some way to go to achieve the sort of patient and public empowerment aimed for in the white paper. So how can we carry this momentum forward?  

Shared responsibility

That comes down to how much as an organisation you are prepared to share the stewardship and responsibility you have for balancing the big three determinants of successful service change: balancing the provision of high quality and safe services with affordability, while carrying the weight of public opinion along with you.

Not easy to do at the best of times, these sort of organisational judgements are going to be a lot more difficult as the effects of the global economic crisis bite hard into public services. The history of business practice has many examples of managers delivering on affordability by cutting corners on quality. Clearly this is not an option in healthcare management now or in the future world envisaged by the white paper.

The regulatory environment will not compromise on the quality of care to patients, while increasing the legitimacy of the public and service users means we are all going to have to be more sensitive to diverse needs, at a time when resources are likely to be severely constrained.

We spent months developing and refining options for how we might deliver acute and community services across five hospitals. The plans aimed to satisfy the demands of five distinctly different communities while ensuring the provision of safe, high quality healthcare services. Our local scrutiny committees insisted that we deliver our case for change by continuing to provide the full range of district general hospital services from two sites, investing in patient transport and ensuring services are developed close to people’s homes and in their communities through partnership working with social care providers and voluntary and community agencies.

Underpinning all this is an ambition to deliver a service transformation over the next two years that aims to drive our clinical performance and outcomes into the top 10 per cent nationally, reduce our cost base by £30m and dramatically reshape both our workforce and the use of our estate.

So, balancing quality, affordability and public opinion is going to be a tough ask. If we are to deliver on this the thing to do is to go on increasing our legitimacy with our patients and public.

As Franklin D Roosevelt said: “The only limit to our realisation of tomorrow will be our doubts of today.”