Four themes dominated this year’s gathering of the health service clan at the NHS Confederation’s annual conference in Manchester: priorities for the new money, avoiding another winter crisis, re-energising the redesign of clinical services, and finding, keeping and training the staff to do it all.
The health and social care secretary, Jeremy Hunt, indicated the shape of the offer to be made to taxpayers over more NHS funding. It will be tied to “simple goals” on priorities such as cancer treatment, maternity, waiting time standards for mental health support and integrating health and social care.
Hunt and the NHS leadership are pinning their hopes on avoiding another winter dominated by the wholesale cancellation of elective surgery by freeing up 4,000 beds through slashing the number of long stayers. The plan is to cut the number of patients in hospital for more than three weeks by a quarter over the coming months. It is curious that there is not a parallel push to reduce inappropriate admissions of frail elderly people.
In his first speech to the conference as chief executive of NHS Improvement (NHSI), Ian Dalton betrayed a growing intolerance of hospitals failing to get a grip on service reconfigurations, wasting money and staff.
NHSI will be giving a much higher profile to its improvement role, as opposed to its regulatory one, taking a “long, hard and important look” at how services are organised.
Dalton and the NHS England chief executive, Simon Stevens, are gunning for outpatient departments, which have suddenly become totemic of services that waste patient and staff time, undermine productivity and could be replaced with technology such as a telephone.
Last year there were around 64m outpatient appointments, at a cost to the NHS of more than £8bn. Stevens dismissed the outpatient system as obsolete.
As always, hospital boards are in the line of fire. Dalton made clear his frustration that a number of trusts have put in plans for this year that don’t make sense. Mirroring national problems, they have failed to align money, activity and staffing. They have been told to try again.
His commitment to providing more support for leaders was both a promise and a threat as he announced he would be “focusing laser-like” on productivity and the capacity of organisations to improve.
References to productivity pepper the draft workforce strategy (pdf) published by Health Education England (HEE) last year, but it provides little detail on how it could be raised.
Workforce concerns trickled through debates and conversations across the conference – where to find the staff, how to keep them, how to prepare them for automation, how to motivate them to improve services. The news that Theresa May had finally capitulated on making it far easier for doctors and nurses to get visas to work in the UK was welcome, but it is nowhere near a solution.
The HEE chief executive, Ian Cumming, warned of a 115,000 workforce gap by 2027 without action, but after reading the draft strategy, many people are sceptical about HEE’s ability to come up with the right plan and deliver it. Some chief executives and chairs privately expressed vehement criticisms.
There are now intense discussions involving HEE, NHSI, NHS England and Hunt over the workforce strategy, with a tussle for influence. The long-term future of HEE as a separate organisation must be questionable.
But no matter how many visas are issued or how much more health service funding is forthcoming, the NHS will not be able to plan with confidence for its next decade until the funding crisis in social care is addressed. Hunt himself stressed its importance and hinted that there may be progress announced later in the year. Time and again speakers highlighted the need for a comprehensive financial deal for the entire care system. No other birthday present will do.
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