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Editor's blog Friday 25 June 2010: A bullish constitution, no news but some messages: David Nicholson NHS Confederation speech

Message Number One: he wants to stay. The clock has definitely stopped on ‘NHS chief executive Sir David Nicholson (and counting)’. So if Lansley wants to get rid of him, there will be trouble. That was the first message of Nicholson’s characteristically energetic speech to close the 2010 NHS Confederation conference in Liverpool.

Message Number Two: we got no hard news of details or deadlines - the introduction of the new system is going to be a gradual “transition”, over “the next two to three years”.

Message Number Three: you are leaders and you’ve got to lead. Get on with it – it being QIPP and the development of GP commissioning arrangements.

Key lines from his speech included,

“we now have a very detailed programme for five years, which is fantastic for us in the NHS – there’s a real big issue about clarity, consistency and purpose”

“Andrew Lansley was opposition spokesman for six-and-a-half years, he’s talked to many of you in this room. No Secretary of State has ever come into that position with so much experience. He’s also a man in a hurry.”

“The Coalition government has an absolute determination for change, and to make it soon”

“you have to start changing way you think to understand the direction the government want us to go. If you look at big issues like GP consortia, our natural response is to think how governance works, who’s the accounting officer – mechanics of how it’s going to work, but in a sense that misses the point. We’ve got to think as leaders: what opportunities are available … to change services?”

“all the evidence shows that 70% of big change programmes don’t work, and that’s a real possibility. Of the 30% that do, the defining characteristic is not brilliance of fantastic and coherent vision. It’s the management of change and without a transition that’s well-led, this won’t deliver”

“quality is the organising principle going forwards, through empowered clincians and patients with clout”

“how we go forwards with choice and transparency is really important”

“We’ve all got to look at the changes ahead in four ways:
- can I use this to improve quality of patient service?
- can I use this to ensure patients have more say and are more central?
- can I use this to empower clinicians and staff to make changes?
- are these changes consistent with a universal service free at point of use, but not a consumerist system that deals with people who arrive, but goes into the most deprived communities to wrap services around them?”

“the results of the second assurance of world-class commissioning (which we’re publishing at the end of July) show a remarkable improvement … we’ve been building big skills and capacity, which we must not lose”

“this is the time for us who call ourselves leaders to take up this particular challenge … we’ve got to lead”

“I have both smiled and laughed in the presence of the Secretary of State”

“The White Paper is coming out soon, we hope. The transition arrangement is emerging … to put a date on it would be dangerous, because success depends on a series of negotiations with the BMA. Putting a date only gives BMA power”

Conference chair Sarah Montague: “is that it for PCTs?”
DN: “I understand that someone from the DH said that PCTs are “screwed”. We’re trying to find out who it was … that wasn’t appropriate. But there’s an issue for PCTs, if public health is to be run as a national system, and much of their old work goes to GP commissioners, some into the national commissioning board, and some off into providers. There’s an issue of who holds the ring locally – which is a hotly discussed and disputed issue within the Coalition itself. Nothing is settled in relation to all that, and the conversation is going on through the Coalition committee. The issue is one of democratic accountability and managerial accountability. Accountability for local services is essentially political rather than managerial”.

“we can’t have a successful NHS and failing social care”

”This change is going to be slight different: a chemical reaction more than a set of levers. In that changing environment, I will ensure that people are treated with respect and supported. Finally, three things:
1. Focus attention on the purpose. If we lose that, we lose everything. Ensure that you concentrate in improving the quality of service for patients, and on empowering and supporting staff.
2. Be realistic: this is going to be a big, significant management cost saving. Some people are going to lose their jobs, so we have to be realistic, and not give false hope
3. Have confidence - we’ve done great things and made great change: use that confidence for the future.”

“The Treasury are concerned about consortia’s financial performance: so am I. In 2004-5, we lost grip of money, and it was hard-fought since then to get a grip on resource … (which took) effort and time of people in this room … and we shouldn’t lose it. I will not put that financial grip at risk. Never mind the Treasury, it’s got to get past our test.”

UPDATE: The DH have now published a transcript of Sir David Nicholson's Confed speech, which looks pretty accurate.