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.
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
Read our report: Population health systems
See our commentary and analysis on the NHS five year forward view
Catch up with Hugh Alderwick's blog: Will the new GP contract improve care for patients?