Simon Stevens speech to the NHS Confederation Conference 17th June 2016
This was a speech to "health service leader[s]" who have never had a more demanding and complicated time. But, despite all the pressures, he congratulated his audience that the NHS saw 90% of patients in A&E within four hours and that 90% of planned surgery happened within 18 weeks which he said no other "major industrialised country" could claim. He also reckoned that "austerity" across the OECD area had led to "260,000 excess deaths from cancer - but not a single one of them in this country, thanks to the protective effects of the NHS." He was also pleased about one of the world's biggest improvements in unneeded antibiotic prescribing last year.
He went on to challenge anyone to say whether they would prefer to be treated now compared with five or 10 years ago and that there is more compassion and sensitivity in the NHS. He reminded his audience that history did not start with mid-Staffordshire and that before the early 2000s waiting times were more commonly 18 months than 18 weeks.
However, the days of year-on-year spending increases are over and, he argued, the Lansley reforms were attempted solutions to the last set of challenges and not the present ones. He pointed out the little known fact that the FYFV actually said that the NHS would need between £8b and £21b by 2020 to sustain and improve (my italics). To manage at the lower end of the range, the figure the politicians leapt on, would be conditional on access to social care and more effort on prevention and public health. He thought that the result of the Spending Review was therefore as good as could be expected under the circumstances. However there are three important consequences to the settlement for Sustainablilty & Transformation Plans (STPs): capital spending will "incredibly tight" and "it is hard to see" how such development will be afforded; funding for new spending programmes such as in mental health or cancer services is "back-ended" to 2019/20 and that this year is the "reset moment" for NHS finances so "we can pivot off to the rest of ... this [last bit of] this five year settlement..." He argued that it would be best to assume that there will be no interim rescue packages and that any extra money that might appear should be spent on bolstering social care.
Paraphrasing Churchill's "action this day" the next section was headed "action this year." In order to hold a contingency reserve of 1% or £650m against deficits this money had been stripped out of what CCGs would have had to spend on mental health, community services and primary care. To be able to release this cash for its proper purposes finances and operational performance of individual organisations had to be controlled and those in charge would be held accountable.
NHSE now had "its sleeves rolled up" and there would be no more strategy work now we had the FYFV and task force reports on mental health, maternity and urgent and emergency care. He had appointed operational managers in these areas as well as in cancer services and vanguards. There will be two new mental health "waiting time goals" on improving access to psychological therapies and early intervention psychosis services. There will be "more clinical intensity of engagement" in NHS111 and GP OOH care.
He spoke of the importance of primary care and the "huge effort" going into "the very genuine pressures" in general practice. If workforce, work-load and redesign is not got right over the next 18 months then "If general practice fails, the whole of the NHS fails."
STPs are, he said, a set of institutional arrangements, governance structure and incentives that are pulling people apart when we actually need to "hang together" (sic). They need to be "landed" (sic) in every part of the country and
he thought he was optimistic without being naive. Three phrases he wanted to associate with STPs were:
"Horses for courses" with different solutions to solve the problems of each area to provide a focused, honest, trusted conversation about the difficult choices;
"If not now, when?" because although problems had often been known about for years the time had never been quite right before. Well now our "backs were to the wall";
"How big a team are we playing on?" which seemed to refer to successful leadership being agreed across localities and not as the result of "failed arm-wrestles" between managers.
In a nutshell, Mr Stevens said about the year ahead, "It's going to be bloody tough..." To get through it he urged employers to make their employees' burdens lighter by looking at workforce race equality, staff health programmes and encouraging innovation. He gave the example of an iPhone app to allow ECG recording and said it would probably be put on the national tariff next year to detect atrial fibrillation reduce strokes.
In conclusion he said that although he would be making the case for NHS funding forcibly and publicly this would not "buy us comfort and the status quo." The next five years would be "tough sledding" he added, no doubt a phrase picked up from his time in America?
Dr Barry Moyse
Deputy Medical Director