The NHS Chief Executive said that amendments to the Health and Social Care Bill had improved the government's proposals for NHS reform in England.
Speaking at the Commissioning conference in London today (16 June 2011), Sir David Nicholson (pictured) said "I genuinely that we have a much stronger set of proposals for change than we had before", as a result of the NHS Future Forum's 'listening exercise'.
Sir David said: "To make sense of what people were genuinely worried about and turning that into a set of proposals for the government was a very powerful system."
He described the reforms as a "once-in-a-generation opportunity to really move things forward", but insisted this was not a criticism of the way the NHS had previously been managed, but that change was necessary for the "challenges of the future".
However, speaking of the top-down approach under the last government, Sir David said that "as a leadership team of the NHS, we sort of lost our way, we lost the reason why we were there.
"We got so excited in the systems and processes of change – payment by results, foundation trusts, practice-based commissioning – that we forgot why we were here: for improving the quality of services for our patients."
He described clinical commissioning groups (CCGs) as the "main engine of change" in enabling "great outcomes for patients", and said the most important aspect of the new NHS Commissioning Board (NCB) would be its "the relationship with these groups."
Sir David insisted that the starting point of the NCB, which he chairs, would be to help commissioning groups be the best they could be, and that the board would "help and support" local commissioners.
However, David Stout, Primary Care Trust Network Director at the NHS Confederation, expressed scepticism that Nicholson's "warm words" of NCB support would be realised.
Speaking later at the conference, he told delegates that in the past PCTs had generally been "too compliant" in delivering government targets. "I have hopes that clinical commissioning groups will be a bit more resistant to that top-down approach," he added.
Later, Mr Stout told Management in Practice that he doubted the NCB would be seen as entirely supportive of CCGs because of its dual function.
"The NCB will have two roles," he said. "The support role, but at the same time they are going to have to hold [CCGs] to account – firstly by the authorisation process, and secondly by some form of performance relationship. One is soft and cuddly, and the other is hard and painful, potentially."
Asked to clarify his suggestion that CCGs should be more "resistant", he told Management in Practice he was not advising this "to the point of insurrection." But he advised CCGs to "understand your own power and worth. Maybe the NCB won't be too directive, but if it does [end up] telling people what to do then I think a bit of resistance would go down well."
Your comments (terms and conditions apply):
"I must have missed something. I see zero real change. Just a different govt insisting we do what they say how they say it to patients weren't we supposed to be getting away from one size fits all?" – Name and address withheld