ABHI at Confed 19
The largest gathering of senior NHS managers took place in Manchester this week, with the NHS Confederation’s annual conference. Upwards of 1,000 delegates enjoyed a mix of presentations, breakout sessions and discussions about some of the most pressing issues facing the service.
If there was a theme that ran through Confed, it was integration and the need for the NHS, and other organisations that impact the wider determinants of health, to better understand their local populations. That ambition was very clearly laid out in the Long Term Plan (LTP) published in January, and there is no Plan B. Next week NHS England / Improvement will be publishing its implementation programme for the LTP, and three more Integrated Care Systems (ICSs) have been announced, with the NHS on track to have all of England covered by ICSs by April 2021.
As usual, not everything runs completely smoothly. Anita Charlesworth from the Health Foundation, the financial analyst’s financial analyst, suggested that the multi-year funding settlement for health, to which the LTP was a response, may not be sufficient. Welcome as the increase was, a quarter of the new money was immediately diverted to correct longstanding problems, mainly in the acute sector. The freeze on pay is also not sustainable and, added on to other pressures, means that the money could only sustain a growth of 2.3% in support for our hospitals, a figure well below the anticipated increase in demand. Indeed, NHSE/I Chief Executive, Simon Stevens conceded that the reduction in the number of hospital beds envisioned in the LTP was not going to happen, and in some regions bed numbers would have to increase to abate the pressure on them.
Another time bomb Charlesworth identified was the lack of capital spending. The NHS spends half of the OECD average, and its capital budget is often raided to sure up other problems. All in all, she suggested that there was something like a £4bn hole in what was required between now and the end of the settlement, if we were to invest in the systems beyond the NHS that would require support to contribute to the LTP, and a £8bn hole if we try to address the capital shortages as well. Stevens himself agreed that the NHS has a difficult job ahead in winning the argument with Treasury that the NHS needed further capital investment, especially given that investment would have to come from the public purse. Other avenues, such as the Private Finance Initiative, now being closed.
Delivery of the LTP in terms of moving care out of hospitals, has been further retarded by a change to the phasing of the new money. The initial intention was for the increase in spending to be front loaded, allowing the well documented problems in the acute sector, big provider deficits, increasing waiting times etc, to be addressed as well as allowing investment in primary and community care and mental health. The money is now to be backloaded, meaning that, once you have bailed out the acute sector, there is simply not enough left for the NHS to be able to invest in its enabling services. The solutions to filling the black hole do not look appealing. You can increase productivity, although the NHS is famously productive, you can push waiting times out, politically tricky, or you can raid other budgets, and end up with a capital spend half the OECD average.
Generally, Stevens was upbeat about the progress the NHS has made in the past five years or so, but acknowledged that there was work to be done. Very prominent in this was the issue of workforce which remains perhaps the biggest single challenge for the NHS as it tries to deal with 100,000 vacancies, a new cohort of GPs wanting to work more flexibly and a large number of early retirements prompted by changes to pension rules in the public sector. But it was not just recruitment that Stevens was passionate about, it was the need to better look after staff and, as I can confirm as a Board member of an NHS organisation, the health and well-being agenda will be conspicuous in the months ahead. Stevens has also appointed a Chief People Officer for the NHS. Alongside improving care for patients and providing better support for staff, the Chief Executive spoke convincingly about the wider role of the NHS and an anchor role for hospitals in the communities they serve. Typically the largest employer in their communities, with all the impact and influence that comes with it, hospitals have the opportunity, for example, to use digital technologies to provide more sustainable healthcare. The NHS has also appointed a violence reduction lead, offering insight from the experience of dealing with gun and knife crime.
There will be opportunities for our sector for any technologies that can support the operational efficiency of the service. The digital agenda is very much seen as a way to make the service more flexible and begin to address some of the workforce challenges that exist. There is an energy to take forward the recent Topol review, which looked at how technology could best support NHS staff. At the essence of Topol is the ability of technology to give NHS staff the gift of time and allow them to spend more of it on caring for patients.
The link between the delivery of healthcare and economic growth was illustrated by an example from Japan. The country is one of the few, if not the only, in the developed world whose population is decreasing. Proportionately then, the number of older people is increasing quickly. It recognises that it has an increasing dementia problem. Their answer is to become the best country in the world at dementia friendly technology and export it. The Minister responsible for dementia is also responsible for economic growth, simultaneously solving a pressing local imperative and developing the country as a lead in that particular technological area.
ABHI’s work was referenced in some of the many sessions that looked at partnership working, and we will continue to create opportunities for our members to work more closely with the NHS.
