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Opening address: Professor Ian Cumming opens Congress 2009

In his opening address Professor Ian Cumming talked about the forthcoming financial pressures that will present serious challenges to healthcare.

In the last ten years there has been fundamental technological, professional and scientific change that has been underpinned by a growth of investment into healthcare although he wryly acknowledged that it might not always feel like it.

The next five years however will see healthcare, and especially the NHS, have to deal with the consequences of the economic downturn. Despite current political assurances the NHS will not be exempt, nor will the private and independent sector who may find some of their customer base forced to move to NHS healthcare.

Growth in investment and funding will be 5.5% above inflation for the next two years. It will be in 2011-12 that funding will become more of an issue. The best case scenario is funding pegged to inflation, the worst case scenario is 'flat cash', where the same levels of funding are retained but without being pegged to inflation. This of course would not address issues such as demographic changes, technological advances – which has rising costs and budget impacts, or people living longer and needing more healthcare.

One figure that has been bandied about for cuts is £20 billion of efficiency/productivity gain, Prof. Cumming's share of this for NHS West Midlands would be £2 billion. But such cuts can in actual fact cat as a catalyst for change to improve service delivery.

Historically he was keen to emphasise, this must not mean a return to the 1980s where in a low period for the NHS it could not afford new technology or offer training to staff. Staff morale was hit hard by neglect. This had a real impact on the health of the population with a service and workforce no longer fit for purpose.

He believes that the pathology can teach the NHS many lessons because of its use of Lean thinking, efficiency improvement, innovation and better procurement.

So the key question is how do we re-design healthcare services to be higher quality, more accessible and more patient-focused in the context of reduced resources?

Savings can be made through technical innovation, emphasis on early prevention, reducing errors, rationalising of support services, increase in generic prescribing by GPS, decrease in use of drugs and tests of limited value. Prof. Cumming went on to cite examples of looking at maximising efficiency.

One example was the pioneering use of day-care hip replacements which requires investment upfront. But in the long-run this means a third to half patients having their hip replacements completed for patient discharge on same day, which in turn reduces the need for beds which creates big savings.

The NHS Management Board is facing this issue using QIPP – Quality, Innovation, Productivity and Prevention. Increasing quality may be expensive to start with but will cost less in the long run. The problem is trying to re-design the system of growth to one of shrinkage, and achieve more out of less.

Another issue is trying to reduce the impact of poor lifestyle health such as obesity. There is more political emphasis on prevention.

In the last twenty the NHS has made immense progress and it was important not to go back to the waiting list culture of previous eras. Change though is unpopular when it is imposed or enforced from above, it causes resentment and anger. Prof. Cumming was determined to prove there is a choice and the choice is to think and show leadership, to take risks, put heads above the parapets, to influence the wider sphere and get involved in the QIPP solution.

He was surprised by the lack of healthcare scientists in top positions even though their background and experience makes them perfect for influence, leadership and working at the local, regional and national agenda. Leadership is not just at the top but at all levels.

He concluded with some key messages from his talk: be involved but don’t take on the leadership agenda all at once and on your own, don’t bury your head in the sand and pretend it’s not happening and face up to what is a real challenge. Pathology can and must be at the forefront of leadership and has much to offer the rest of healthcare with his experience.

Professor Cumming then went to declare Congress 2009 officially open.

About Professor Cumming

Professor Ian Cumming started his career as a biomedical scientist and later worked as a research scientist in the Haemophilia Centre in Manchester before moving into general management in the late 1980s.

He joined West Midlands Strategic Health Authority from his last role as Chief Executive of NHS North Lancashire.  With 25 years experience in the NHS, Ian has been a Chief Executive for 14 years in acute hospitals and a PCT.  A healthcare scientist by background, Ian has a proven track record of delivery of both strategic and operational management challenges in the NHS.  He has a particular interest in developing clinical staff as leaders and in medical education.  This is demonstrated in his role as Vice Chairman of the UK’s Postgraduate Medical Education and Training Board.  Ian also holds the position of Honorary Professor at Lancaster University Management School.  Ian started as Chief Executive of NHS West Midlands on 8 June 2009.