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Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.

Ben Gowland went to Confed 2015 and found that just like "scouse" - the signature dish of Confed's Merseyside home - some parts of the content were less digestible than others.

Ockham Principal Consultant Ben Gowland took up the invitation to "walk and talk" at the NHS Confederation 2015 Conference last week. His footsteps are echoing still....

The context for this year’s conference was set initially by the election result: the relief that follows the knowledge that there isn’t going to be yet another big change, immediately tempered by the ongoing dissatisfaction with the status quo. In the days preceding the conference we had major press announcements about the need to control agency expenditure, and missives from on high ordering a review of executive and senior pay and limiting consultancy expenditure.

In the Main Hall the main message was all about the £22bn challenge. Clearly concerned that delegates had got carried away by the election pledge to commit an additional £8bn into the NHS, both Simon Stevens and Jeremy Hunt were keen to emphasise the other part of that particular deal, namely that the NHS has to deliver its £22bn worth of savings. If we start operating collectively, as one organisation, we can deliver huge in-year procurement efficiencies. The development of new hospital chains is just one mechanism of making this happen.

Of course we had the mandatory new announcements. Simon Stevens announced the identity of the first three ‘success’ economies (cue relief from everyone else; current experience of the system has not created any belief that those named are in for a fun time). Jeremy Hunt has persisted with his pet project of CCG league tables, and seemed to enjoy showing the packed hall what the new scorecards would look like. For impassive CCG leaders it is just one more stick to be beaten with.

And in a move that I suspect they will come to regret, the leaders of the six national bodies sat on the stage at the end of the day for a panel discussion. ‘All white, all male panel. Are we really in 2015?’ is just one example of the umbrage taken both by the audience and more widely on twitter. Likened to a boy band, asked if they were heading in one direction, it all left the lingering sense that we still have a long journey to go on if we are going to get away from the pervading top down culture of the NHS that consistently prevents the modernisation that is spoken of so frequently.

But, almost in marked contrast, there was huge energy in many of the breakout sessions. Devolution, collaboration, integration, the new models of care and making prevention real were the order of the day. Delegates were hungry to find out what had been achieved and how it had been done, and what they needed to do next. There really is a genuine enthusiasm for the 5 year forward view and the new ways of working that it suggests. Maybe it provides hope in the midst of crisis.

The question exercising everyone seems to be how do we enable the rapid adoption of best practice? On the stage we had the old approach, proven not to work over many years, of restrictions, controls and demands that everyone complies with national directives. Less local freedom to ensure greater national compliance. Jeremy Hunt persisting with the illusion that if he pulls a lever it is connected to the front line and he can make change happen, just like that. But, as one speaker so enigmatically put it, ‘The NHS is not a whale. It is a shoal of fish that looks like a whale, all swimming in different directions’.

In stark contrast, in the breakout sessions the spread of good ideas was happening organically. To probably take the marine metaphor too far, we were learning to fish. If we know the old ways don’t work, let’s at least try something different. One almost got the sense that delegates are so used to top down directives that they have become immune to them, able to let them wash over them while they channel their energies into the things that they think really do matter. For all our sakes, let’s hope so.

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