In her latest entry in the #Transformation2019 series, Sue James shares a recent conversation about commissioners that got her thinking

Magnifying glass

Magnifying glass

I was asked recently about the “blindspots” for transformation, the quick answer to which was that (by definition) we don’t know.

But it made me think, and perhaps a blindspot we can shed some light on is something about commissioners really understanding the demographic drivers of demand, and where these drivers will take us without mitigation.

I would assert that without this, we might find that we have successfully implemented every demand management approach that we can think of without being able to reduce demand to an affordable level, because of demographic growth and changes in lifestyle.

I don’t see this happening; I think it’s a blindspot and I’m keen to hear reactions from commissioners in particular.

Another issue that I feel we are unsighted on is any modelling about how providers manage to reduce services without exposing uncovered fixed costs. Demand will probably not reduce in a neat step wise basis which will allow providers to reduce services by, say, a ward at a time. This will make the income and expense position of trusts even more volatile than it is at present.

Sue James is chief executive of Derby Hospitals Foundation Trust