Simon Stevens' vision for the NHS: welcome but challenging to deliver

In his keynote address at our annual integrated care summit, Simon Stevens gave what was arguably his most important speech since he took up post. His speech contained three big messages.

The first was that the NHS needs to act urgently to tackle growing financial and operational pressures. He argued that provider overspending of almost £1 billion in the first quarter of this year was the result of the high costs of agency staff and the transfer of £1.1 billion from the NHS budget to the Better Care Fund. He announced that NHS Improvement - the combined provider regulator bringing together Monitor and the NHS Trust Development Authority - would take action soon to tackle the escalating costs of agency staff, seeking to convert these posts into permanent roles where possible. His uncompromising message was ‘if we lose control of our finances, we lose control of our destiny’, a wake-up call if it were needed to everyone present as well as those not in the room.

Stevens’ second message was the need to press ahead with the NHS five year forward view (Forward View) and the new care models being pioneered by the vanguards. He particularly emphasised the need to strengthen primary care and out-of-hospital care, using the opportunities offered by the new voluntary contract announced by the Prime Minister at the Conservative Party Conference. NHS England is bolstering its team through the appointment of Arvind Madan from the Hurley Group in south London to provide leadership on this agenda.*

His third message was that the NHS should avoid the distractions of the foundation trust pipeline and mergers and acquisitions and focus instead on using available funding to transform care. This would require organisations working in the same area to come together and bid for funding above their base allocations. Essentially, NHS England would be top slicing the NHS budget for 2016/17 in order to galvanise providers and commissioners to agree local transformation plans. Depending on the detail of how this works, it could represent a major change of direction for how resources are allocated within the NHS.

Stevens’ argument for systems of care to collaborate echoes ideas outlined in our paper on population health systems and our forthcoming paper on systems of care to be published next month. The principal barrier to progress, raised by Polly Toynbee of The Guardian during questions at the summit, is how to square these ambitions with the legacy of the Health and Social Care Act 2012. This is where NHS leaders need political support to avoid falling foul of stakeholders who see moves to stimulate collaboration between NHS providers as a way of frustrating competition and the entry of new care providers.

In laying out the lie of the land so clearly, Stevens has challenged ministers and others to come to the aid of an NHS already in financial crisis and facing the prospect of a crisis in patient care unless action is taken urgently. There are, however, real difficulties in acting on some of these messages. While action to control spending on agency staff is overdue, it will not deliver big savings this year, and the ability of the NHS to recruit to permanent posts remains to be tested. As we have argued elsewhere, the new voluntary contract presents a significant opportunity to improve services for patients, although it remains to be seen how much enthusiasm there is for it among GPs.

The proposal to invite areas to bid for funding may stimulate partnership working but more information is needed on how the footprints of these areas will be determined and how NHS England will assess the plans they submit. There is an obvious risk too that the bidding process will generate work and income for management consultants at a time when resources need to be directed at patient care. Even more important is how NHS organisations will cope with growth funding being withheld until plans are approved when arguably this funding is intended to ensure the sustainability of existing services rather than pump-prime transformational change.

Stevens was surely right to say that ‘to will the ends is to will the means’, an argument we advanced in our paper on the implementation challenges of the Forward View earlier this year. The challenge now is to design the means intelligently to avoid perverse consequences and to help local leaders navigate the treacherous waters that lie ahead.

*Arvind is a member of The King’s Fund’s General Advisory Council

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Comments

#545010 John Lish

There is an additional danger to the risks identified by Chris Ham in bidding for pots of funding and that's how to establish longer term funding of successful partnership working.

Having seen local pots work in bringing together partners including different health agencies, it is a methodology that can generate partnership working or just be used as replacement funding for existing services (BCF has generated this behaviour with local authorities).

So the challenge is how NHS England is able to continue to support successful partnership working beyond the initial financial stimulation. There needs to be some clear thinking about how continued commissioning works (or decommissioning where experiments fail to achieve results). Stimulating new patterns of working is the easier part of the challenge.

#545012 Pearl Baker
Independent Mental Health Advocate and Advisor /Carer
Independent

Listening to Simon Steven you would think it is only about health, no mention of LA Authority funding at all. LA cuts will soon escalate the NHS budget even higher. I will explain why, in my area the LA have cut all 'funding' to special needs children, this will lead to more depression amongst parents unable to work or have a break, and in my opinion more 'residential care placement' for children they can no longer support.

As an Independent Mental Health Advocate and Advisor you are required to know all there is to know about health and social care, including housing, LAWS and legislation Human Rights United Nations Convention Equality Act 2010 are just a few to mention.

In my opinion unless there is a radical review of how Social Workers are trained there cannot possible be any improvement, at present they are an 'ad hoc' group of agency staff and very few employed staff.

GPs are failing their patients due to the poor understanding of how health and social care could or should be 'integrated'. Patients are left in 'limbo' when they have an emergency situation, no co-ordinated system in place by those responsible for 'integrating' health and social care, particularly at weekends.

I will often accept a Carer or their relative, and from beginning to end solve their problems, it is not helped by an un-coordinated system of health and social care.

I have come to the conclusion that the only way forward is for more individuals like me well trained, and educated in a complicated system of delivery.

I continually listen to all those Professional who think they are coming up with another great idea, only to find someone else is also thinking up a 'great idea' along similar lines, but all think these is the best, so much money is wasted, when all Carers and patients want is to be cared and supported as they should be, emergency contact number, and everybody to follow all the Law, Act legislation, Convention Human Rights Act etc., are a few to mention. To be successful in a delivery of proper health and social care you must be equipped for the 'JOB'

The CQC are misleading the Public in thinking they are 'protecting' all those receiving health and social care when they are NOT, they need to come clean and explain exactly what they do, and to promote 'Safeguarding' as an alternative to their concerns.

The CQC has to explain exactly what their duties are to the General Public, and when this is explained, it will soon become clear this is where and why 'poor health and social care' continues in 2015, with no plans to change the current 'format'

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