Stevens warns NHS on cash and change

NHS England has turned three areas with persistent financial and service challenges into ‘success regimes’ to receive greater central support, Simon Stevens told an audience of NHS leaders earlier today.

Speaking at the NHS Confederation conference in Liverpool, the commissioning board’s chief executive said that North Cumbria, Essex and North East and West Devon had been identified by all six of England’s NHS national bodies as areas that needed to be put on a “sustainable footing”.

“We all know there are parts of the country that are in systematic imbalance in terms of either the quality or structure of their services or their ability to make money work. And they have been imbalance for years if not decades,” he said.

Stevens told the conference that NHS England had “tested to destruction” previous methods of improving failing NHS economies – such as replacing chief executives and short-term bailout funding – and a new way was necessary.

 “The idea is that we are going to collectively, both locally and nationally, bring to bear our full range of flexibilities and say what is our holistic diagnosis of what needs to change in this individual health economy, not just go in and inspect individual institutions.”

Stevens made it clear that the implementation of success regimes was just one of a number of tough measures that would have to be taken by the NHS as it looks to implement the ‘Five Year Forward View’ to address a gap between demand and funding that could reach £30 billion by 2020-21.

Although the Conservative Party pledged to find an additional £8 billion for the NHS in its manifesto, Stevens said there will be no extra money for the health service this year.

“We see no likelihood of the NHS receiving additional cash this year. We will have to manage the resources allocated to us,” he said.

He also urged managers not to wait to implement change. The 5YFV calls for investment in public health and in new service models, which may lead to reconfigurations that are unpopular locally and to more services being delivered digitally.

Stevens acknowledged that political support was necessary, but said he expected to get it. Immediately, he said NHS England needed to have “challenging conversations” with clinical commissioning groups and trusts to set realistic levels of demand and potential for funding growth.

He also emphasised the importance on using NHS England’s wide resources to commit to collective actions to “get a grip” on big cost drivers, such as temporary staffing where he said there is a £1.8 billion overspend.

Another pressing concern for Stevens is to redesign the way the urgent and emergency care system works especially in light of the major struggles over winter, where many hospitals failed to hit A&E targets.

“We know that it is pretty confusing if you are member of public,” said Stevens, saying that when faced with a choice of services such as NHS 111 and urgent care centres, they often pick A&E for simplicity.

“We’ve got to do a far better job of joining this up from public point of view.” NHS England’s medical director Sir Bruce Keogh is currently leading work in this area through the implementation of the Urgent and Emergency Care Review, published in August last year.

In an attempt to make the system more simple for members of the public there are plans to bring the NHS 111 phone service and the website NHS Choices under one online banner called NHS.UK.

Stevens also touched on the importance of joining up health and social care in his speech, acknowledging that there needed to be a “conversation” about funding for social care, which was noticeably absent from the political rhetoric in the run up to last month’s election.

Social care has not received a commitment similar to the £8 billion pledge for the NHS, a situation that the Association of Directors of Adult Social Services is going to condemn tomorrow, on the back of a survey showing that cuts are leading to a residual service, as councils retrench to their statutory responsibilities.

“We need to think about health and social care funding together,” Stevens said, adding that this includes the potential of integrated personal commissioning – in which an individual gets a combined health and social care budget – at one end of the scale, and large-scale devolution – such the devoManc experiment in Manchester – at the other.