LATEST ARTICLES
Brexit is bitter pill for the care system
29 June 2016
The vote to leave the EU is likely to inflict significant damage on the health
service.
In the next few months, the biggest threat to the NHS comes from a
recession-driven round of additional spending cuts hitting non-ringfenced
budgets such as social care. It would be political suicide for a government
led by a pro-Brexit prime minister to cut NHS spending itself, since more
funding for the NHS was at the centre of the Vote Leave campaign. That
exploitation of the health service gives NHS England chief executive Simon
Stevens a little leverage with the government – but not much.
Further cuts to social care would be almost as bad as direct funding cuts,
and would significantly exacerbate the financial problems of the acute
trusts.
It is possible the new Conservative party leader – when appointed – could
go to the country with a manifesto pledging to ease austerity, pushing the
target date for a budget surplus beyond 2020. The chances of achieving that
looked shaky even before the referendum and 2020 was always an arbitrary,
self-imposed target. But the NHS would only benefit if any promised easing
of austerity outran any damage inflicted by falling tax receipts.
Read the full article on the Guardian Healthcare Network
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Stevens spells out tough times ahead
24 June 2016
There was something akin to desperation in the speeches by health service
leaders at last week’s NHS Confederation conference in Manchester.
Wisely, there was little attempt to inspire the troops with misplaced rhetoric.
The contributions from the two chief executives – NHS England’s Simon
Stevens and NHS Improvement’s Jim Mackey – were business-like and
practical. The unspoken title was “this is how we get out of this mess”.
The focus was purely on delivery, with no time for policy. As Stevens put it:
“NHS England is out of the strategy business.”
There were announcements of a “new programme to fast-track cutting-edge
innovations from across the globe to the NHS frontline”, but Stevens barely
bothered to mention this breathlessly-worded hype in the hall, knowing it
was all but irrelevant in the face of the financial crisis.
It is becoming increasingly apparent that the £8bn of additional government
funding will not be enough. Stevens, defending his position, reminded the
conference that the target set out in the Five Year Forward View of £22bn of
savings was predicated on robust investment in prevention and social care.
But he also sought to bury the idea that the government could be pushed
into finding yet more money, pointing out that even if extra cash did
become available it should probably go to social care.
Read the full article on the Guardian Healthcare Network
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Don Berwick: NHS can deliver reform
15 June 2016
As the financial crisis mounts and performance deteriorates, renowned
American healthcare expert Don Berwick says he has a “high and growing”
confidence in the ability of the NHS to find a way through, with staff
determined to change the way they deliver care – but central interference
could wreck ambitions.
Berwick built an international reputation as president and chief executive of
the US-based Institute for Healthcare Improvement, bringing a scientific
approach to the quality, safety and cost of healthcare systems.
His latest role is working with NHS England and the King’s Fund to support
the “vanguard sites” developing the new care models outlined in the Five
Year Forward View.
Instinctively optimistic, Berwick describes the vanguard progress as
“stunning”. His upbeat assessment is based on the determination he sees in
the workforce: “You might expect local staff to say ‘leave me alone, I’m
trying to get through the day, how can I possibly reinvent care at the same
time?’. But exactly the opposite is going on. The spirit, the determination,
the soulfulness, is really deep. I’m sure internally they are meeting some
resistance – not everyone wants to change – but it’s real.”
Read the full article on the Guardian Healthcare Network
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Can Stevens’ local plans break deadlock?
27 May 2016
The NHS is showing impressive ingenuity in finding ways round the chaos
caused by Andrew Lansley’s reforms, but some of the solutions risk causing
a new set of long-term problems.
From the structure and role of the regulators to the commissioning of
primary care, the NHS has gradually stitched together a tapestry of
organisations and processes to do what needs to be done, then backfilled
the governance to ensure it stays within the law.
The next round of the reforms is dividing the country into 44 sustainability
and transformation “footprints”. NHS England bills them as merely collective
discussion forums, but the truth is that they are now seen as central to
delivering the Five Year Forward View and making the NHS financial and
clinically sustainable.
With clinical commissioning groups (CCGs) having largely been unequal to
the task of driving through the tough decisions needed on restructuring
hospital services, the sustainability and transformation plans (STPs) due to
be submitted to NHS England and NHS Improvement in June are intended to
force answers to difficult local questions.
Each footprint has a leader, almost invariably a major figure in health or
local government, with the clout to bring all the local players together and
force discussions to a conclusion.
Read the full article on the Guardian Healthcare Network
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More cash is the only way out of crisis
13 May 2016
Two documents released in the last few days reveal both the severity of the
NHS’s financial crisis and why it cannot find a way out.
In a briefing prepared for Sarah Wollaston’s health select committee, NHS
England revealed more of the detail behind the £22bn of efficiency savings
the health service is supposed to make by 2020-21 to tackle the growing gap
between funding and demand.
It said that around £7bn of this will be achieved nationally, such as through
pay restraint, leaving £15bn to be found locally. Out of this, £9bn is
supposed to come from providers. The Five Year Forward View spelt out the
enormity of this task, with providers needing to improve their efficiency by
2% every year – impressive compared with the NHS’s own history, the rest
of the UK economy and other countries’ health systems.
Key to achieving this was investing in new models of care, and less efficient
providers catching up with the best.
But, as the Health Foundation pointed out, the NHS delivered just £1bn of
savings last year, which means it is already a long way off target barely 18
months after the Forward View was published.
Read the full article on the Guardian Healthcare Network
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NAO exposes NHS England’s failures
29 April 2016
The National Audit Office has exposed another NHS organisation for system-
wide failures – poor financial controls, disjointed services, incomplete data
and staff with the wrong skills. The culprit is NHS England and its
commissioning of specialised services.
Specialised services are huge business for the NHS, consuming almost
£15bn last year – about 14% of the total NHS budget – and slated for 7%
growth in 2016-17. Around 300 health organisations provide at least one
specialised service, which cover everything from specific mental health
problems to chemotherapy.
The ability of NHS England to manage this budget is crucial – if it cannot
control the costs, it will impede the adoption of new treatments and
technologies while sucking yet more money into the hospital sector.
NHS England took control of specialised service commissioning from the
strategic health authorities in 2013. For trusts struggling to maintain staff
numbers it may come as a shock to find in the NAO report that the number
of NHS England full-time equivalent staff involved in commissioning
specialised services has jumped from 287 to 489 in just two years, taking
costs from £20m to £38m.
Read the full article on the Guardian Healthcare Network
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GPs are leading way on transformation
15 April 2016
If there really is a transformation in the delivery of NHS services in the next
few years, it will be overwhelmingly thanks to primary care, not hospitals.
Primary care is the most agile part of the care system, is at the forefront of
prevention, and is uniquely placed to make a big difference to people’s lives
at relatively low cost. And despite all the headwinds, progress is being
made.
While it is the financial vortex of the acute sector which grabs the headlines,
primary care is itself under immense pressure; at the extremes there are
frightening stories about the toll that GP workloads are taking on some
doctors’ mental health.
Many clinical commissioning groups are struggling to maintain GP
involvement in the face of huge clinical workloads and the difficulty of the
commissioners’ work, although the fact that nearly all CCGs will have taken
over responsibility for primary care commissioning by next year should
provide at least some encouragement that they can make progress in
reshaping local services.
Read the full article on the Guardian Healthcare Network
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Can NHS Improvement save the NHS?
1 April 2016
The launch of NHS Improvement on Friday marked the beginning of a
relentless effort to pull the NHS back from its financial crisis. When the
government announced plans to merge regulators Monitor and the NHS
Trust Development Authority into NHS Improvement it promised a new
approach. Technically its role as a regulator is unchanged, but the priority
now is to ensure local areas make the tough decisions to ensure financial
and clinical sustainability, while helping organisations and health economies
embedded systems for improvement.
Helping providers improve while compelling NHS bodies to collaborate
around new models of care are the only cards left to play. Commissioning,
structural reorganisation, targets, the internal market, patient choice,
sackings, outsourcing, regulation, inquiries, reviews and more sackings have
all failed to secure financially sustainable, high-quality care. The Five Year
Forward View set out a vision and direction; in the face of the relentless
deterioration in NHS finances, the central bodies now have to accelerate its
implementation while forcing the system back into financial balance.
Setting up NHS Improvement finally resolves the confusion of the central
bodies. In the aftermath of the Lansley reforms and the Mid Staffordshire
scandal NHS England, Monitor, the Trust Development Authority and Care
Quality Commission were all in the mix; now the leaders are NHS England
on the commissioning side and NHS Improvement for the providers.
Read the full article on the Guardian Healthcare Network
April to June 2016
Public Policy Media
Richard Vize