Breakfast Seminar

“It’s a good time to reflect on NHS England’s progress so far, and consider its future direction,” Bob Ricketts told delegates, as the organisation had just passed its first birthday and appointed a new chief executive.

The answer to the question of where the NHS should focus its efforts was ‘blindingly obvious’, he said, given the ever-widening gap between resources and demand. “The NHS faces unprecedented challenges to its survival. I’ve worked in health for 30 years and I can’t remember a time when demand and capacity were so ill-matched, and the graph is still going in the wrong direction.”

The demographic pressures of an aging population were well known, he said, coupled with rising expectations from the public and politicians. There had also been some very high profile quality failures, and stark variations in quality across the country remained. Outcomes were still often poor compared to much of mainland Europe, and there were resource constraints that could potentially add up to £30bn.

“We’ve got a growing mismatch between resources and investment that isn’t going to be dealt with by incremental change,” he told the seminar. “The financial warning signs are very clear.” Most delivery systems across primary, secondary and specialist care were over-stretched and increasingly out of date, he said, and there was also a need to “stitch the commissioning system back together”.

“The NHS and its partners, including local authorities, need to find bold, transformative solutions that re-shape services at pace and at scale. We’re going to have to get a lot more value out of the system in the next two to three years. There are huge opportunities, but it’s also quite worrying in terms of what’s going to need to be delivered.”

New chief executive Simon Stevens, however, had used his inaugural speech to stress that he wanted to create a health system that could solve the ‘really big challenges’ of dementia, obesity, inequalities and mental health, as well as boost empowerment and personalisation, delegates heard. “His comment that the traditional partitioning of services no longer really made sense was also hugely liberating, in that it gives us the possibility of opening up whole new packages of care.”

Integration was vital, and NHS England was still only just coming out of managing a major transformation of the commissioning system, he stressed. “We’ve got a very clear goal, which is high quality care for all, and not just for now.” The delivery model for this would be evidence-based, with effective leadership, he stated. “We’re starting to see some good clinical leadership in terms of really engaging communities.”

Alongside championing innovative commissioning, the organisation’s priorities included “making sure we’re getting funding and resourcing right”, a commitment to transparency and a comprehensive review of incentives across the system. “It’s very much a comprehensive change model, and the challenge is to stick to that and not deviate,” he said. “To deliver great outcomes for patients and value for the system we need an excellent commissioning system that’s aligned around need and place. It has to be needs-led, driving up quality now and leading service transformation for the future, enabled by at-scale, professional commissioning support.

“I’m quite optimistic that if we back them, the Clinical Commissioning Group (CCG) leaders will make a difference,” he continued. “But we need to accelerate and seize the opportunities to use innovative commissioning and contracting to change the system. There’s a real desire and opportunity to re-design primary care to expand the borders, and a renewed focus on integration and strengthened partnerships with local government. In terms of strategic planning, you work back from where you want to be in five years time.”

NHS England wanted to keep CCGs “lean, focused and evidence-based”, he said. “If commissioning can’t work with clinicians and patients in the driving seat then it makes me wonder what other model there could be. We need commissioning approaches that incentivise high quality integrated pathways which deliver high quality, joined-up care, make best use of resources and address demand explicitly.”

Developments in outcome-based commissioning were also encouraging, he told the seminar, although in a period of austerity this “could be tricky. There’s no getting away from the fact that money is incredibly tight and will stay that way for the foreseeable future. But there’s a growing consensus among clinicians and GPs on the need for change, and that’s something to build on.”

Overall, any kind of change of the magnitude the NHS needed to go though was difficult, he said. “But then add in local and national politics, lack of resources and the need to keep the show on the road at the same time. But I am optimistic. Because there’s no alternative.”