£21bn funding black hole calls for widespread transformation, says NHS chief executive, Simon Stevens
The NHS needs to find up to £21billion by 2020 in order to sustain and improve services - calling for a widespread transformation and the adoption of inovative medical technologies, said service chief executive, Simon Stevens.
Speaking at the NHS Confederation Annual Conference in Manchester last week, he also warned there would 'not be prudent to assume any additional NHS funding over the next several years', leaving trusts needing to innovate to meet promises to enhance services.
The challenges are different, the financial circumstances are different, and therefore our response needs to be different
In his keynote speech, he told delegates at the event: "I know it’s tough for frontline staff across the NHS and there has never been a more-complex time to be a health service leader.
"Despite all of the pressures, I challenge you to ask any doctor, any nurse, any patient in fact, 'would you rather be treated now compared to five years ago or 10 years ago?'. The fact is that anybody who knows what they’re talking about would say that the quality of care on offer to the people in this country, for the vast majority of conditions, is better now than it has ever been. And that’s not just true for the clinical quality of care; it is also due, I think, to the compassion and the sensitivity with which care is offered."
But he used his speech to warn of though times to come and claimed the next 12 months would be critical in reining in spending and delivering improvements to services.
"During the 2000s, certainly, the big challenge confronting us was how to use a substantial wodge of extra cash and turn that into improved access and shorter waiting times across the NHS.
How the health and care system evolves in different parts of the country will look different. That is fine. The solution for Lincolnshire will not be the same solution for South East London. That is OK – but it does need to be a solution
"However, as we also know, the circumstances facing us now are different. The challenges are different, the financial circumstances are different, and therefore our response needs to be different."
The NHS Five Year Forward View reveale that the NHS would need between £8billion-£21billion pounds by 2020 in order to sustain and improve.
And, to be at the lower end of that range, it would need to see continuing access to social care and a vastly-enhanced effort on prevention and public health.
Stevens said: "We have a U-shaped funding settlement which – against a very-difficult fiscal backdrop – I think can be regarded as as good as would be obtainable under those circumstances. And so overall NHS funding, as you know, will go from about £100billion pounds to £119billion over this period.
"But there are three important consequences of the recent Spending Review which are really relevant for the conversations we are having now.
"First, the capital is incredibly tight so, as we think about our plans – our care redesign in the 44 geographies across the country – solutions that are heavy on capital expenditure, right now it is hard to see how they are going to be financeable.
"The second impact is that a lot of the improvement we want to see in new funding programmes – be it mental health services, cancer or others – the extra purchasing power for that – regrettably in some ways, but just as a matter of fact, let’s be honest about it – a lot of that extra purchasing power is back-ended towards the 2019, 2020 period.
"The third consequence of this U-shaped funding settlement is that this year now really matters. We have got to use 2016/17 as the reset moment to get our finances, our performance, back in a place where we can then pivot off to the rest of what this five-year settlement looks like.
"Times are clearly tight and tough.
It is going to be bloody tough; let’s just be frank about that. But that is what the nature of the leadership challenge is in front of us right now
"We have got to get our sleeves rolled up, and get delivering on some of the key national priorities and strategies that we have laid out."
Improving social care and the links with the NHS is crucial, he added.
"I do not believe that it would be prudent for us to assume any additional NHS funding over the next several years, not least because I think there is a strong argument that were extra funding to be available, frankly we should be arguing that it should be going to social care. That is one of the arguments that I have been making publicly, and I think social care has a very strong case for that.
"We have got to get our sleeves rolled up, and get delivering on some of the key national priorities and strategies that we have laid out.
To help with these aims, Stevens has appointed five operational managers to the NHS. All women, they will connect the national implementation agenda with the local work that has got to be delivered in every part of the country. They will cover key areas such as mental health, cancer, maternity services, and urgent and emergency care.
He said: "How the health and care system evolves in different parts of the country will look different. That is fine. The solution for Lincolnshire will not be the same solution for South East London. That is OK – but it does need to be a solution.
"Yes I’m afraid there will be a reset on the money, and it is my job honestly to tell you that. So we might as well recognise that and be getting on with it, rather than waiting for it to come and bite us later in the year.
"We know that there are a set of practical things to continue to show progress on – mental health and cancer and learning disabilities – and there are other national priorities.
"It is going to be bloody tough; let’s just be frank about that, too. But that is what the nature of the leadership challenge is in front of us right now."
We can see innovations, our clinicians can see innovations, that will make a difference, but which we are not getting out and about
Innovation in medical technology will be key, he added. This will be driven by the announcement that, from April next year, a new piece will be added to the national tariff system specifically for new medtech innovations that have been shown to be cost-saving or help patients with supported self-management."The fact is, the NHS is also an incredibly innovative organisation, and has been since the year dot," he said.
"If you want to know where IVF, vaccinations and transplants came from - it was the NHS.
"But we are leaving money on the table and leaving opportunity unaddressed. We can see innovations, our clinicians can see innovations, that will make a difference, but which we are not getting out and about.
"[The new tariff] is not the ‘be all and end all’, not a solution to all that needs to get done – but it is a way of trying to fast track beneficial innovation into frontline clinical practice; to take the hassle out of having to try to negotiate these things on a trust-by-trust or practice-by-practice basis.
"The reality is that, actually, if you sort of begin to look at what some of these prospects are, it can get quite energising and quite exciting."
Providing examples of where medical technology has helped with outcomes, he added: "Here is my iPhone - here is an ECG machine now for under £100. We are probably going to put this on the national tariff for next year. Two million people in this country have got atrial fibrillation, and 20% of strokes are caused by that, a lot of it undiagnosed. We have different parts of the NHS beginning to use this technology. We should just make that a national reimbursable part of what we offer.
Is not the ‘be all and end all’, not a solution to all that needs to get done, but it is a way of trying to fast track beneficial innovation into frontline clinical practice; to take the hassle out of having to try to negotiate these things on a trust-by-trust or practice-by-practice basis
"Likewise for COPD, we have health apps being used for the million patients with COPD, 90% of whom struggle to administer their treatments. So when we talk about the £22billion savings and we talk about demand management and all of the rest of it, it is things like atrial fibrillation and COPD.
"And things like intensive care units – 20,000 patients a year get ventilator-assisted pneumonia, with a 30% mortality rate. It turns out there is a small inflatable tube you can put in patients throats, and as a consequence that practically eliminates the risk of pneumonia-related death. We are using it in Birmingham – but not across the NHS – saving £700 a patient.
"Let us get these kinds of innovations diffused much more quickly, much more widely. And I think that if we do that, we will see, not only alignment with clinicians who generally are up for and excited by and can see the benefits of this; we will see the benefit for patients. And it is a much more inspiring and encouraging way to go about modernising our care delivery than simply the grind of cost take-out and reduction through conventional means."