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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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