This week the NHS held its annual NHS Confederation Conference in Liverpool, providing an opportunity for the NHS to set out its stall for the next five years. With clear endorsement from the new Conservative Government for the NHS Five Year Forward View (FYFV), all eyes were on Simon Stevens, Chief Executive of NHS England, as he set out his stall.
The clear message he gave was that the FYFV enables the NHS to 'chart its own destiny' for the first time in its history. He noted that, for the first time, there is a consensus on what needs to be done across the whole service, including support from the public who have made it abundantly clear that maintaining the NHS is important to them. However, he emphasised the danger of focusing on the future without squaring up to today's pressures, and that collective action is needed now.1
Indeed he identified four priority areas:
- Action on deficits - putting the NHS on a sustainable financial footing. No extra money this year so one of things have to get right is to have honest talks and collective action around capacity planning. It also requires a focus on reducing spend on temporary staffing, including using the collective purchasing power of the NHS underpinned by realistic workforce plans. At the same time recognising that commitment of at least £8 billion additional real term funding by 2020 leaves a predicted funding gap of £22 billion requiring efficiencies and increased productivity, a reduction in clinical variation and a more mature approach to utilising the NHS's collective purchasing power.
- Redesigning care by embracing a triple integration which ends the demarcation of physical and mental health while combining health and social care and blurring the boundaries between primary and specialist care. Something already begun by the recently announced vanguard sites and which also requires more networked solutions for small and medium hospitals.
- NHS leaders being encouraged to use their authority to back the new public health agenda and in particular to support health and wellbeing through prevention. With a particular emphasis on tackling obesity and targeting reductions in Type 2 diabetes to try and reduce the prospect that otherwise a wave of avoidable illness will engulf the NHS unless action is taken now.
- New ways of working both locally and nationally and the need for a change in the public conversation about health; requiring a redesign of how the healthcare system works. For example, closing residential and learning facilities and transferring resources to support personalised care, with a focus on the family and patient held health and social care budgets. Also on this agenda is the need to transform primary care and re-design urgent and emergency care services including a reformed 111 service, specialist trauma and stroke units and better signposting to enable the public to choose the right options.
One specific action that was referenced was the introduction with immediate effect of a new 'Success Regime' aimed at creating the conditions for success in the most challenged health and care economies. With this in mind three health and care economies, North Cumbria, Essex and Northern Eastern and Western Devon have been selected as the first localities to enter this regime, with immediate effect (3rd of June). Implementation will be overseen jointly by NHS England, Monitor and the NHS Trust Development Authority, working closely with the Care Quality Commission.
Particular emphasis was also given to the need to address the capacity and access problems in primary care. In recognising the need to strengthen primary care he noted that primary care currently involves some 370 million consultations a year and A&E, 23 million, if 5 per cent of primary care consultations switch to A&E, A&E visits would double – clearly something completely unwarranted and unmanageable. Indeed he suggested increased funds could come to general practice 'in the short term' in the form of 'at least a third of a billion pounds' in return for demand being absorbed in general practice rather than hospitals. He also said NHS England would soon be making a 'big announcement' around pharmacists and practices working closer together, while describing general practice workforce issues as one of NHS England's 'must get right' things for the next five years. In return, Simon Steven's expects that general practice would also have to work more efficiently in new care models such as multi-speciality community providers and GP federations.
In conclusion, Simon Steven's stated that "It's a tough challenge but we have a plan, an NHS that's up for it, and 54million people on our side." While this may appear a bit glib or simply too simplistic, the areas identified do chime with of our own research findings and indeed it does appear that for once there truly is a consensus of what needs to be done. What is clear is the NHS can't deliver the transformation on its own; more than ever it will need new funding and business models to support partnership working within and between the public, private and charity sectors. As identified in our recent report on Connected health, it will also have to speed up its adoption of digital technology to support these new ways of working in order to deliver the much needed productivity and efficiency savings.
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