The new chief of the NHS Confederation, Mike Farrar, has told the government to stop attacking managers in the health service as they implement radical changes and called for "long term transformation not short term fixes".

Speaking at the organisation's national conference in Manchester, Mr Farrar  opened by giving a run-through of a survey of 287 chairs and chief executives of NHS organisations which revealed many of their concerns as the service sets out to save £20 billion over four years.

The poll makes for pretty miserable reading with 87% of those polled saying the financial situation facing their organisation is either “very serious” or "the worst ever experienced". Half think that patient access, including the availability of care and waiting times, will get worse over the next 12 months and three quarters say that cuts in local authority spending on the NHS will definitely impact on the services provided.

Mr Farrar said people will "overlook these worrying results at their peril" as "this is the view of those who run the service, who will implement the reforms, and on whom the immediate future of the NHS depends". He went on to say that "they are unconcerned with the political knockabout and they don't have the luxury of the armchair commentators".

The CEO also noted that the NHS also feels pressure "as a consequence of the difficult financial settlement for social care", which highlights that "the NHS is not an island. The health and social care system has got to work together or it will not work at all". However, he said the results of the survey "should not be seen as a counsel of despair but a statement of reality and a huge wake-up call".

Management cost targets 'crass'

He went on to say that "we need a proper assessment of the resources needed to manage the NHS effectively, and this means moving away from a simplistic and crass management cost target with all the perverse incentives it entails". Mr Farrar argued that "no one disagrees with the need to find efficiencies" but "an organisation the size of the NHS, with £110 billion of expenditure, needs a proper level of management to succeed".

He said most comparable countries "spend more on management than we do, without getting the outcomes and services" and 'the latest management reductions bring us dangerously close to undermining the advantages we have. High quality management is the solution, not the problem".

Mr Farrar told the Confed members, who warmly applauded his speech, that "we need to take our destiny back into our own hands by delivering long-term transformation not more short term fixes". He added that "we need the confidence to shape our own destiny, to innovate from within, not to wait for others to do it, and to challenge our own outdated business models".

The CEO also claimed that "we cannot expect the taxpayer in days of tighter economic growth to fund greater and greater injections of funding, although we can and will lobby for sensible and appropriate settlements for the NHS and social care - especially at a time when we are now going backwards against the spending levels of similar economies". 

He went on to praise the "brilliant work" of think-tanks like Kings Fund, the Nuffield Trust and the Health Foundation, but said the Confederation "will not be a think-tank but a do-tank".