THE NHS Confederation annual conference, which starts tomorrow in Birmingham, gives senior managers and non-executives in the NHS a valuable opportunity to take a step back and discuss how we can improve patient services.

This annual event also gives me the opportunity to reflect on what has changed over the past year in the world of health. It seems extraordinary that, just a year ago, we hadn’t even heard of commissioning a patient-led NHS. This major structural reorganisation of the NHS has dominated the thoughts of senior managers and non-executives for nearly a year.

Unsurprisingly, such a major reorganisation tends to divert attention from some of the important issues and, instead, leaves people worrying about their job and their future. Amazingly the NHS has become used to handling the repeated changes without breaking step. However, it is inevitable that establishing new NHS organisations creates anxiety for those who work in primary care trusts.

As we move forward, there are a number of important challenges. One of the most important is how we ensure that the boards which will lead the new organisations are helped to develop and flourish in the new system.

Every board, and board member, must take responsibility and accountability for the decisions they make about the health of the population they serve. They must lead the transformation of the healthcare system into one that is lean, effective and technologically adapted to the needs of the 21st century: a service that is focused on the type of responsive services that the baby boomer generation will wish to use for themselves and their families.

The lesson from the establishment of foundation trusts is that to deliver change, boards need the freedom to lead and take responsibility. In a publicly funded system this must be supported by public assurance systems that reassure taxpayers that their money is being spent to best effect and that predicts problems and prevents them happening rather than blaming people after the event. This requires an effective regime to deal with organisational failure without allowing patient care to suffer.

This means a new approach to governance: a performance framework that focuses on outcomes, not targets, and allows organisations to develop their own priorities and processes. This requires a more sophisticated performance management system that aims to ensure success, recognises that communities have differing needs and respects the local solutions planned and executed by management and clinicians.

Non-executive directors and those who work in the NHS share a strong public service ethos. But this ethos still requires boards to exercise financial control and take the tough decisions required of them. Every pound spent inefficiently is a pound that cannot be used to benefit another patient. In the NHS, tackling inefficiency is a moral imperative, not an optional extra.

If boards manage to deliver in the new organisations that make up the modern NHS, and I am quite sure they will, they will deserve political support from all parties and an end to the situation where the NHS is treated as a political football where the highest patient-satisfaction rates for the service (92 per cent find its treatment good, very good or excellent) are not even reported and certainly not praised.

Dame Gill Morgan is chief executive of the NHS Confederation

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