Local managers will have to “use a bit more nous” when commissioning services in order to ride out the recession, according to health minister Mike O’Brien.

In a speech last week to the Westminster Health Forum in London, Mr O’Brien placed responsibility for delivering better quality NHS services with less money squarely on the shoulders of local commissioners and managers.

He told delegates at the seminar that the government would not let up on its quality agenda, despite the tighter fiscal environment.

Mr O’Brien said: “[NHS chief executive] David Nicholson’s challenge to managers to find efficiency savings is not about slash and burn cuts, it’s about focusing on quality and innovation, productivity and prevention. It’s about better commissioning of services.”

He said the government was trying to convince commissioners to “think in new ways”. He highlighted the potential of telemedicine as an example of where patient care could be improved and money saved.

He said up to a million patients took anticoagulants such as warfarin, and that self testing and monitoring at home could reduce the need to regular visits to GPs or hospital clinics.

“What we need to do is ensure that commissioners recognise that they are being asked to use a bit more nous, a bit more intelligence about where and how they run an organisation of this size,” he said.

“There are opportunities – there are always opportunities – to improve the quality and efficiency of what they do. We now need some new, clear commissioning that recognises the quality of what is being done for patients must continue to improve,” said Mr O’Brien.

However, NHS Confederation chief executive Steve Barnett warned that the government would need to better support local managers if it was to achieve its aims on quality and innovation.

“There has to be the incentives and the environment in which managers can be allowed locally to do that. Just exhorting managers from on high to work better, work smarter, improve quality and innovate will not do it in itself. There has to be the right culture and environment to allow that to develop.

“Where I do think there is an area of neglect is with investments in training and development, and resourcing of talent at middle management level across the health and social care systems,” he said.