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Published: 20/06/2002, Volume II2, No.5810 Page 13 14

Medical managers showed at their conference last week that they are an independent lot.And to prove it it, they gave Alan Milburn and panellists from government bodies quite a grilling.Tash Shifrin was there

Remember novelty band Doctor and the Medics?

Perhaps It is better not to, especially as - in this 'health service of all the talents' - medical managers are doing it for themselves.

For delegates at the annual conference of the British Association of Medical Managers in London last week were not afraid to get on down, shake a tail feather and generally do their 'thang' at the session dubbed 'the BAMM jam'.

However, the musical efforts of the clinicians' finest were not the only jam BAMM delegates could relish, as health secretary Alan Milburn popped in to announce the outline of the new consultants' contract. Always nice to be guaranteed some applause for the cameras. But the positive response did not mean Mr Milburn escaped unquizzed at a conference notable for participants' efforts to tease out the reality of the new possibilities opening up for the health service.

University Hospitals Coventry and Warwickshire trust deputy medical director Steve Evans probed for more insight on patient choice, pointing out that at his hospital, heart patients on the waiting list had been offered the option of another provider.

But, he said, 'when we ask patients, they say they would rather stay on our waiting lists'.

Mr Milburn acknowledged the point. 'Where people have instituted choice for patients. . . the choice that patients exercise is not to choose at all.

'You have got to raise standards across the piece and have the right levers to make that happen, ' he said. But his next remarks seemed to suggest the patient choice idea might have an ulterior motive: hoping patients choose somewhere else to relieve the pressure.

'This is as much about matching supply to demand as it is about patient choice, ' he said.

Patient choice was right because 'we live in a choice-driven world'.

'It is also a very rational way to ensure you get the best out of the capacity there is in the system, whether That is NHS or private hospitals.' Food for thought for the delegates.

More nuggets were provided at a panel discussion, featuring Commission for Health Improvement director Dr Peter Homa, Clinical Governance Support Team director Aidan Halligan, National Clinical Assessment Authority medical director Dr Alastair Scotland and chief social services inspector Denise Platt.

Unfortunately the Patients Association representative had been unable to attend, and - in the one wrong note of a lively conference - BAMM asked a doctor to role-play a patient participant. But the panellists proved a spiky bunch. Ms Platt, invited to give 'a short precis of her world' began by debunking a favoured buzz phrase. 'I do not agree with seamless services. In my experience they are baggy and ill-shaped.'

Well-seamed services, 'properly sewn together', were more useful, she said.

And she did not pull any punches over bed-blocking. 'Half the patients are sitting there for health service reasons, not social services ones, ' she said. By concentrating on delayed discharges, We are bringing in more and more people into acute care as people find the best way to get into residential care is from a hospital bed.

We are heating up the system.'

The BAMM delegates do not really do sharp intakes of breath - they seemed to enjoy the challenge.

Ms Platt was requested to explain further by Pinderfields and Pontefract Hospitals trust medical director Keith Judkins.

'Sometimes if something is all our jobs, it ends up being no-one's job, ' Ms Platt replied. Lots of people were 'stuck' because the pharmacy was not able to dispense their drugs at the right time or ambulances were not ordered in time for patients' discharge, she said.

Dr Homa had questions to answer, too. His reference to 'newCHI', the forthcoming Commission for Healthcare Audit and Inspection - prompted questions about the removal of 'improvement' from the commission's title.

The CHI chief reassured delegates that improvement would be central to the new body's work, while 'part of its task is to redefine inspection'. And when Dr Homa's organisation took over star-ratings, they would 'increasingly include more pertinent, authentic and valuable measures of patient care', he pledged.

BUPA medical director Andrew Valance-Owen spotted another gap in the government's joinedup thinking, asking whether the NCAA and CGST would look at consultants' work in the private sector. The panellists were forced to confirm that both bodies' remit stopped at the edge of the NHS - it was a pity Mr Milburn had not stayed on to take notes.

Ministerial types might also have gained from the serious and thoughtful discussion on leading change in clinical services. Perhaps the speaker, Ara Darzi, as the Department of Health's surgery adviser, will be able to report back.

Professor Darzi's description of picking his way round the minefield of hospital reconfiguration in Kidderminster and then acute services at County Durham and Darlington illustrated the increasing closeness of medicine and management.

And assorted clinicians in a packed side room chipped in to debate whether acute medicine really needed to be co-located with acute surgery and whether a primary care-led diagnosis and treatment centre could work.

A passionate speech by NHS University chief executive Bob Fryer about the dearth of postschool learning in 'the learning century' might also have shocked a New Labour minister or two, with its references to class, socioeconomic groups and dockers' leader Jack Dash.

Mr Fryer has graphs to illustrate the 'straight correlation between participation in post-school learning and social class'. He told delegates it was important for everyone to share in responsibility for the development of learning. 'If the NHS University reproduces this pattern by 2010, close us, ' he challenged.

It felt as if he might end by bursting into song. Good job the BAMM people had their musical instruments just in case. l Naked ambition: EasyJet and other healthcare models 'Leadership is the new NHS fashion accessory, 'declared Birmingham Heartlands and Solihull Hospitals trust chief executive Mark Goldman, introducing day three of the BAMM conference.

The emphasis on 'general'and 'clinical'management as the panacea for the NHS's ills had been replaced, said the former surgical medical director, by a need to show the leadership required to deliver reform and meet targets.

Mr Goldman appears to have a laissez-faire attitude to fashion - he admitted to practising his speech 'naked in front of the football'.But he knows about leadership - his was one of four trusts rumoured to have narrowly missed out on being named in the first wave of foundation hospitals last month.

Mr Goldman said that it was his goal to deliver 'the EasyJet of healthcare'- efficient and affordable. In achieving this, clinicians, he claimed, were often better placed to exercise leadership and solve problems than 'managers and accountants'.Their knowledge of, for example, alternative and cheaper treatment methods could be vital in balancing budgets while maintaining care standards.But, he warned, clinicians needed to set aside old rivalries - between professional groups and primary and social care - if they were to make progress.He related the trust's difficulties in reducing the 15 types of sterile rubber gloves previously ordered by the various specialisms to just one - producing an annual saving of£70,000.

Good procurement practice could have other benefits, he said.Describing his trust as 'a small city of opportunity in the midst of need', he picked up on the message contained in the recent King's Fund Claiming the Health Dividend report (news, page 10,16 May), and complained that the NHS was failing to use its purchasing power (people and goods) to 'exert a positive influence on the locality'.

The conference was closed by NHS chief executive Nigel Crisp.Fresh from a visit to a palliative care unit in north London, Mr Crisp once again climbed on to his soapbox to exhort greater efforts from the NHS legions (medical managers brigade).He reassured his audience that government - from the prime minister down - was happy with 'the basic structure'of the NHS and planned to 'stick with it'.

The 'organisational confusion' the service was suffering from had been foreseen and acknowledged as the price to be paid for making progress at the pace required.He answered sceptical enquires about foundation hospitals - which he said would bring greater managerial and financial freedoms, as well as a greater closeness to the public.Quizzed about foundation status at primary care level, he suggested that certain elements of primary care may never be considered suitable, while others - community hospitals for example - might.

But he concluded by warning against the service descending into a distracting debate about organisation just as the pressure to deliver began to build.He identified September, when activity levels for the first three months of this financial year would become known, as the next big public test as to whether the NHS is worth the investment it has received.

Alastair McLellan