news focus: A full 18 days into one of the most momentous bouts of service reorganisation, what do senior NHS managers think of the show so far? Paul Dinsdale reports

Published: 18/04/2002, Volume II2, No. 5801 Page 14 15

Given that the 28 strategic health authorities are still in their swaddling clothes and that most primary care trusts only came into the world on 1 April, a gathering of senior NHS managers to discuss improving performance in the new NHS seems - well, a bit previous.

Junior health minister Lord Hunt was understandably keen to show how committed the Department of Health was to the new structure - though even he acknowledged it was still early days.

In his opening address, he emphasised that reducing the number of people waiting 15 months for an operation from 80,000 to two - announced as part of the NHS chief executive's report last week - was an important milestone, although he admitted there was still a long way to go to get performance to desirable levels.

The London conference, organised by management consultants Laing and Buisson, gave an overview of the performance issues that were top of the government's agenda - among them, the role of the Modernisation Agency, clinical governance and the Commission for Health Improvement, and how the independent sector fits into the picture.

The focus of Lord Hunt's speech was an old chestnut: the importance of information management and technology to the NHS, and how this had fallen below standard in many areas of activity. A large number of reports on acute trusts by CHI had highlighted a lack of information-sharing by clinicians and managers, he noted.

When pressed by a questioner after his speech, Lord Hunt acknowledged that funding for IT was part of the problem: 'We are going to have to find investment for information management and IT because there hasn't been enough in the past and we can't keep re-inventing the wheel.'

He said the setting up of an Office for Information on Healthcare Performance as part of CHI had 'enormous' potential for gathering data on treatment outcomes, among other things, and would provide a solid basis on which to assess trusts.

But his speech also called for more attention to individuals in the NHS: 'The introduction of the comprehensive patient survey programme last January will help us to make service improvements in the NHS and will cover a range of issues, such as patient views on admissions, attitudes of staff and treatment, ' said Lord Hunt.

'The National Patient Safety Agency is drawing up guidelines on adverse events and we will be receiving much more information on these and medical errors in future. As the Kennedy report on Bristol Royal Infirmary showed, patient safety has not been a high enough priority in some parts of the NHS.'

One of the main aims of the conference was to put the new strategic health authorities under scrutiny.

Having just taken over as chief executive of North West London SHA, Professor Ron de Witt was at pains to point out that he did not want to create a heavy-handed, top-down approach to setting targets: 'I want PCTs to be able to anticipate what we want from them, ' he says, 'so that we do not have meetings where I have to say 'Why haven't you done this or that?'.'

In line with this principle, the SHA would put in place a simplified performance-monitoring system, with quarterly reviews of progress of its seven PCTs and twice-yearly reviews of trusts.

Giving the view from the Modernisation Agency, director of service improvement Michael Scott defined modernisation in more down-to-earth terms as 'the service we would want for ourselves and our relatives'.

As examples of the great 'modernisation' mantra in practice, he said that every hospital in England has met targets to bring in booked admissions for at least two high-volume patient groups; and that every cancer network is making changes as part of the cancer services collaborative.

He also pointed out that most of this activity had been instigated in the past 18 months.

'Many of the people at the Modernisation Agency have been on secondment from the NHS and are now going back into the service to implement some of the ideas they have picked up while working with us, and this is what we need, ' said Mr Scott.

As evidence of how change is spreading, he noted that around 800 clinical teams were now participating in collaborative networks in the NHS in England and that 60,000 staff had taken part in training on how to redesign local services around patients' needs.

There were also two concrete examples of where services had been improved dramatically at local level. In Somerset Coast PCT, GPs and physiotherapists have created an extended physiotherapist role to identify musculo-skeletal problems at an earlier stage.

By carrying out investigations into patients' spinal, back, shoulder and knee problems at an earlier stage, they can identify the cases which need to be referred to a consultant and have managed to cut outpatient waiting times to nine weeks.

In another example of changing practice, Peterborough Hospital trust has set up a consultant-led assessment unit on trolley waits and cancellations, with consultants taking it in turn to run the unit for a week at a time, including taking calls from GPs and supervising all discharges.

It has also initiated an assessment scheme for cataract surgery with a local chain of optometrists, which means that patients do not need a GP or pre-op outpatient visit.