news focus: It is time for systems - not individuals - to change, managers told HSJ 's inaugural Breakfast with Champions .Paul Stephenson was there

Published: 11/4/2002, Volume II2, No. 5800 Page 20

They are a keen lot, these modernisers. They are alarmingly wide awake at 8am and happy to talk about redesigning the health service over breakfast, and to top it all they do not mind being chastised for not making enough progress.

The first HSJ Breakfast with Champions, sponsored by PricewaterhouseCoopers, was held in London and took as its subject making modernisation mainstream.

Delegates heard that if managers were concentrating on meeting government targets, they were getting it wrong. Specifically, they were told they should be redesigning services around patients so that meeting waitingtime and financial targets was routinely achieved without being the focus of managerial effort.

The audience of managers from London and the south of England were explicit about the problems of trying to achieve change and meet targets at the same time, but it was clear they knew that was what was demanded of them. Speaking for many, Guy's and St Thomas' Hospital trust director of nursing Irene Scott said a lot of what was going on felt like 'saving our own skins' by making sure targets were being met, rather than changing the way things were done.

In reply, Dorset health authority chief executive Ian Carruthers said that although everyone was under pressure, it was wrong to lay the blame on targets. The right course was to ensure that their organisations were well run: 'Too many organisations have dysfunctional planning processes. I can't understand how people have£50m deficits if they have a functional planning process.

'The reason why we have this pressure is because we want to avoid the problem, and the easiest thing to do is say we have a financial problem. The financial problems are symptomatic of management failure. It is not the targets that are the problem, but our management processes.We are repackaging this by saying we are short of facilities.

We are short of action.'

Mr Carruthers argued that if services were changed with the patient in mind, everything else would flow from that: 'We need to think patient first, system second, organisation third. Most places I know think of organisation first.'

But he made it clear that individuals could not shoulder all the blame. He said it was better to coach them 'until they do it right' rather than 'removing them': 'We need to change our attitude to say this is about developing people.'

Mr Carruthers told HSJ he agreed with the concept of franchising - but the responsibility for change shouldn't fall on individuals: 'We shouldn't assume there is an endless pool of people.We need to concentrate on changing the system, not just the people.'

Modernisation Agency director David Fillingham reinforced the message that patients had to be at the centre of change.He described the experiences of a patient he had known in his previous job, who had been well treated by the NHS but believed that there was room for major improvement.

'He felt he had been given more information when he went to buy a washing machine than when he was told he was on medication for the rest of his life.'

Though Mr Fillingham said the key to improvement was to 'find a better way of doing things - not different, better' - he acknowledged that there had been some loss of enthusiasm for modernisation: 'When the NHS plan was published, I think frontline staff were very enthusiastic, but we lost a lot of that because people saw it was being imposed.'

Given the constant reiteration to ensure patients were at the centre of change, it was left to Alzheimer's Society chief executive Harry Cayton to praise the NHS for being far better than other countries in providing long-term care: 'We are very hung up on acute services.

Very many health service users are long-term users, and yet all we see in the media is waiting times and heart transplants. I would rather have Alzheimer's disease in the UK than in Germany or France.

'I think we need to reassert the value of the health service in longterm care. We really undervalue what we have achieved in that area.

If you look at the American system in Alzheimer's or AIDS - forget it.'

Mr Cayton said patient involvement was key to improving services. But he asked, 'Where are they - patients - going to come from who are ill enough to count as patients, but will want to spend two days a month on patient forums?

'The second problem is skills.

The danger is the usual suspects - the middle class, the articulate and people who use the health service least. The third problem is representativeness. I do not think one needs to get too hung up on this [but] I am not sure [British Medical Association chair] Ian Bogle is representative of doctors.

'The area I am hearing patients are having a lot of difficulty getting involved in is primary care.

My feeling from my membership is that primary care trusts are the most resistant to the involvement of the local community.'

On the strength of the enthusiasm at the first Breakfast with Champions - many of them from primary care - patients might find they really are being listened to. l www. hsj. co. uk/champions The next meeting is in Birmingham on 16 May.