A of leading national health bodies in England have published a series of nine targets that the NHS should aim to satisfy over the next six years.
The plan, which covers the period leading up to the end of the decade, is backed by £560 billion of NHS funding.
It collectively sets out guidance for the health service in a period of extreme financial and logistical challenges.
“Delivering the Forward View” sets out “steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service and to improve quality of care, wellbeing and NHS finances.”
Included in the plan is a new, dedicated sustainability and transformation fund, which will be worth £1 billion in the next financial year, rising to nearly £3.5 billion by the end of the decade.
This is intended to “help get hospitals back on their feet, support the delivery of the Five Year Forward View, and enable new investment for critical priorities such as primary care, mental health and cancer services.”
Guidance included in the report is aimed at outlining a new approach to NHS services, ensuring that the health service can retain its quality of performance throughout the rest of the decade.
Simon Stevens, chief executive of NHS England, was positive about the provisions outlined in the document, outlining that it can play a major role in the stabilising of the NHS until the end of the decade.
“This guidance sets out the next steps to make the vision set out in the Five Year Forward View a reality. A new approach to how local NHS leaders plan to meet health needs across whole areas will sit alongside the new Sustainability and Transformation Fund. Together they will help to ensure the NHS has solid financial foundations from next year, and to transform how care is delivered up to 2021,” Stevens commented.
One aspect of the planning of the NHS that has not changed is the individual operational plans that must be put in place in the next financial year.
However, each health and care system within the United Kingdom must work collectively in order to produce a separate Sustainability and Transformation Plan (STP) to cover October 2016 to March 2021. This is a new aspect of the guidance.
The nine ‘must do’ targets for 2016/17 are:
1. Develop a high quality and agreed STP
2. Return the system to aggregate financial balance.
3. Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues.
4. Get back on track with access standards for A&E and ambulance waits
5. Improvement against and maintenance of the NHS Constitution standards that more than 92 percent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice.
6. Deliver the NHS Constitution 62-day cancer waiting standard, including by securing adequate diagnostic capacity; continue to deliver the constitutional two-week and 31-day cancer standards and make progress in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage two; and reducing the proportion of cancers diagnosed following an emergency admission.
7. Achieve and maintain two new mental health access standards [and] continue to meet a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia.
8. Deliver actions set out in local plans to transform care for people with learning disabilities.
9. Develop and implement an affordable plan to make improvements in quality particularly for organisations in special measures.
The boss of NHS in England has suggested that specialist hospitals can play a major role in clinical innovation going forward.
Simon Stevens stated that such institutions should share best practice and develop new care models in order to play a major role in the future of the health service.
Stevens has just penned a forward to a report by the Federation of Specialist Hospitals (FSH).
The report was launched in Parliament on 25th November.
Commenting on the potential of specialist hospitals, Stevens suggested that such institutions have already established an excellent track record across the NHS.
“As we radically redesign care, now more than ever before we need to seize the opportunities that science and new treatments offer patients. We must maximise the impact of these centres of excellence and spread their learning across the rest of the health service,” Stevens opined.
Continuing on his theme, Stevens outlined the successes of the new care models programme.
“Through the new care models programme, we are already supporting specialist networks, like those led by The Christie, The Royal Marsden, Moorfields Eye Hospital and other federation members, to serve a wider population.”
In the published report, it is recommended by the FSH that specialist hospitals can make a particularly valuable contribution to the fields of clinical research and innovation.
This potential should be recognised and supported by the implementation of national policy, with the Accelerated Access Review considered particularly important.
The launch event for the report saw a team of significant figureheads from across the whole service assembled.
These included former care minister Norman Lamb MP, minister for life sciences George Freeman MP, and FSH chair and national director of clinical quality and efficiency at the Department of Health, Professor Tim Briggs.
Commenting on the report at its launch, Professor Briggs suggested that specialist hospitals have particular characteristics that support their ability to engage in cutting-edge innovation and research.
“Specialist hospitals are characterised by their focus on a single speciality and, usually, by a disproportionately complex casemix. As such, specialist hospitals are often home to investment in cutting-edge innovation and are substantial contributors to clinical training and research.”
Briggs continued by emphasising the importance of such institutions to research in the NHS, and the commitment of those present at the launch of the support of this concept.
Adding to Briggs’ comments, Rob Webster, the chief executive of the NHS Confederation, suggested that there was a fertile environment in the NHS for this initiative.
“There has never been a more important time for this, as innovation is fundamental to transforming NHS care and finding greater efficiency. As a champion of the Accelerated Access Review, I am grateful that this report reinforces that the ultimate test of the Review will be how effectively the health system is able to adopt and spread innovations like these for the benefit of our staff, our patients and the NHS.”
According to the Chief Executive of NHS England, the plans of the Chancellor of the Exchequer for the funding of the health service are simply not workable.
George Osborne has already outlined his scheme for NHS funding until the end of the decade, with the forthcoming spending review thought to be of particular importance.
However, ahead of the release of this formal document, Simon Stevens has indicated his belief that negotiations on health funding require considerable progress.
Stevens suggested that the level of funding promised by George Osborne could not be reasonably described as genuinely workable.
With a £30 billion deficit facing the NHS between now and the end of the decade, Osborne had already pledged an increase of £8 billion in spending by 2020.
The further gap in funding is to be achieved via efficiency savings according to the plans of the Conservative government.
However, Stevens has stated his belief that it is a vital for the NHS to pledge extra cash in the short-term in order to kickstart service changes that will lead to desired savings in the longer term.
“As of today, considerably more progress is going to be needed before we can say we have a genuinely workable NHS funding solution for 2016-17 and 2017-18, but spending reviews usually come down to the wire, so hopefully we’ll get there by 25 November,” Stevens stated.
The NHS is merely one department reliant on government spending that will be affected by the forthcoming review.
In a statement in November, the Chancellor of the Exchequer already indicated that the Department of Communities and Local Government will have their budgets cut by 8 per cent on an annual basis.
Similar cuts have also been made with regard to the Department for Transport and Environment.
Meanwhile, Osborne is reportedly still in talks with a raft of cabinet ministers ahead of the key funding information release date.
Work and Pensions Secretary Iain Duncan Smith, Home Secretary Theresa May and Foreign Secretary Philip Hammond have all been in discussion with the Chancellor over potential cuts to the departmental budgets.
Decisions to cut government departmental spending can be seen in the context of the overall economic position of the United Kingdom.
The British government is currently in the region of £1.7 trillion in debt, with the figure inching ever closer to 100 per cent of GDP.
This is compounded by a spending deficit still in the region of £100 billion per year.
Although the £1.7 trillion figure may sound substantial in itself, when unfunded liabilities are taken into consideration the real scale of debt is likely to be somewhere between 3 to 4 times this number.
The head of NHS England has thrown his hat into the immigration debate, encouraging the government to reconsider its policy toward nurses.
New proposals from the government will see lower paid nurses from outside the EU deported.
But Simon Stevens acknowledged the rather well-publicised fact that the nursing profession faces a shortage of qualified employees at present.
Naturally nursing is absolutely critical to the everyday functioning of the NHS, and leaving the health service short of nurses is tantamount to handcuffing it.
Stevens is merely the latest high profile source to offer a negative opinion of government policy.
The deportation approach has already been criticised by employers’ groups and the nurses’ union, both of which consider it to be a disastrous piece of legislation.
It is already projected by some experts that the policy could ultimately cost millions in recruitment, in addition to the staffing difficulties that it could create.
Both of these groups have already urged the Home Office to add nurses to the list of shortage occupations, effectively exempting them from the new legislation.
Additionally, it has been suggested that the £35,000 salary threshold is far too low, and that this should be reconsidered for the nursing profession.
Under existing rules, workers from outside the European Economic Area who are earning less than £35,000 after six years in the UK will be deported.
Most experts seemingly agree that this will lead to organisational difficulties, if not outright chaos.
Meanwhile, speaking at the Institute of Directors annual convention in London, the NHS England chief executive became the most prominent healthcare figure in the UK to offer a forthright opinion on the subject.
“Understandably we’re having a national discussion about how to get immigration right. My responsibility is to point out that, at time when the need for nurses is growing, when publicly funded UK nurse training places will take several years to expand, and when agency staff costs are driving hospital overspends right now, we need to better join up the dots on immigration policy and the NHS,” Stevens stated.
The Chief Executive also compared nursing to ballet dancing, calling into question the logic and rationality of the existing legislation.
“Most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. However, most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. And most hospitals tell me the idea that we would seriously consider deporting some of our most experienced and committed nurses solely because they’re not earning £35,000 clearly needs a rethink,” Stevens commented.
Stevens is just the latest individual to criticise the government policy.
The Royal College of Nursing has already estimated that in the region of 3,500 nurses could be affected by the legislation.
This could effectively cost the NHS over £20 million in recruitment alone, with the ultimate financial and organisational cost considerably higher.
And the union claims that the figure will rise to in the region of 30,000 nurses by the end of the decade, should workforce pressures lead to increased international recruitment.
This mammoth number would require in the region of £180 million to recruit replacements alone.
NHS England has today announced an initiative intended to impact positively on the health and wellbeing of staff in the service.
The Chief Executive of NHS England, , will outline the plans aimed at the organisation’s 1.3 million employees speaking at the NHS Innovation Expo conference.
Measures introduced as part of these plans will include serving healthier food, promoting physical activity, reducing stress, and providing health checks covering mental health and musculoskeletal problems.
These latter two issues are purportedly the largest causes of illness absences in the NHS. Overall absences in the health service are estimated to cost the taxpayer £2.4 billion per year. To put this figure into perspective, this amounts to approximately 2.5 per cent of the total NHS budget.
Three principles will be at the heart of this new health initiative. Firstly, there will be a major drive intended to promote improved NHS staff health. This will be conducted by a group of leading NHS hospital, mental health, ambulance, community and clinical commissioning group employers, and partnered with NHS Employers and Public Health England.
Secondly, a new occupational health service will be particularly targeted at GPs; a tranche of the NHS that particularly suffers from high levels of stress and burnout owing to long hours. This aspect of the programme will be partnered with the Royal College of GPs and BMA General Practitioners Committee.
And, thirdly, there will be a specific focus on catering, with the aim of delivering healthier food options within the NHS. In order to achieve this, NHS England will work closely with Public Health England.
Speaking on the new initiative, Stevens stated that “NHS staff have some of the most critical but demanding jobs in the country. When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order.
“At a time when arguably the biggest operational challenge facing hospitals is converting overspends on temporary agency staff into attractive flexible permanent posts, creating healthy and supportive workplaces is no longer a nice to have, it’s a must-do.
“And at a time when the pressures on GPs have never been greater, we need to extend the local practitioner health programmes that have been shown to help GPs stay healthy and get back to work when sick.
“Equally, it’s time for PFI contractors and catering firms to ‘smell the coffee’ – ditch junk food from hospitals and serve up affordable and healthy options instead. Staff, patients and visitors alike will all benefit.”
However, the approach to addressing the issue has been criticised in some quarters.
By implementing this new approach to health within the NHS, the health service is explicitly acknowledging that working within the clinical professions is becoming increasingly stressful. When this is combined with the relentless pursuit of cost saving measures, attempting to squeeze ever more juice from already stretched resources, then this inevitably results in more sickness absences.
Some have suggested that this an unsustainable situation that must be addressed directly, rather than merely attempting to alleviate problems with measures that singularly fail to tackle the root cause of the issue head-on.
Additionally, the overall budget for the scheme is £5 million, which when spread across the 200 trusts in the NHS ultimately represents a rather paltry figure, considering that the average trust typically employs around 5,000 people. One can calculate that this initiative will represent little more than a few pounds investment per member of staff.
Nonetheless, Christina McAnea, UNISON Head of Health and chair of the NHS Social Partnership Forum, was still willing to publicly acknowledged what she considered to be a positive development. McAnea commented that “the health and well-being of NHS staff at work has a direct impact on patients and this initiative rightly starts recognising that. Addressing physical and mental health issues is important and a step in the right direction as it will help tackle some of the major causes of stress at work.”
NHS England Chief Executive Simon Stevens alongside NHS Five Year Forward View partners today (Friday 24 July) announced the launch of eight new vanguards that will transform urgent and emergency care for more than nine million people.
The new vanguards, eight in all, are being introduced to build on recent success in improving trauma survival rates; they are tasked with changing the way in which all organisations work together to provide care in a more joined up way for patients.
It is planned that urgent care will be delivered, not just in hospitals but also by GPs, pharmacists, community teams, ambulance services, NHS 111, social care and others, and through patients being given support and education to manage their own conditions.
Another aim of the vanguards is to break down boundaries between physical and mental health to improve the quality of care and experience for all.
“Starting today, the NHS will begin joining up the often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effectively, 7 days a week”, said NHS England’s Chief executive, Simon Stevens.
“That’s why we’re backing what our frontline nurses, doctors and other staff, in partnership with local communities, to radically redesign our urgent and emergency services.”
Today’s launch of the vanguards comes in the face of pressure on all NHS frontline emergency services, with increased A&E attendances and emergency admissions, and both ambulance and NHS 111 services facing rising demands.
Simon Stevens, chief executive of NHS England, is to give oral evidence to the House of Commons Health Committee from 9.30 am today, Tuesday 21 July.
The Committee is expected to question Mr Stevens on a variety of matters affecting the NHS, including the financial performance of the NHS, prevention and public health, the NHS workforce and staffing, urgent and emergency care, mental health services, and the post-Francis Review progress on changing culture in the NHS.
Ahead of the session, the Committee has received a statement from NHS England on progress with the NHS Five Year Forward View, published last October.
Tomorrow’s oral evidence session will be open to the public and will take place in the Thatcher Room, Portcullis House. The session will also be broadcast live on www.parliamentlive.tv/Commons and on BBC Parliamenthttp://www.parliamentlive.tv/Commons
In a far-reaching speech made today in the West Midlands, NHS Chief Executive Simon Stevens set out his vision for the NHS.
Mr Stevens said: “Last Autumn the Health Service came together to chart a shared direction for our country’s NHS. Patients groups, caring professionals, national leaders – uniting behind the NHS’ own ‘manifesto’ for the next five years.
It’s a plan for better health, more personalised care, and a financially sustainable Health Service. An NHS which at all times ‘thinks like a patient, and acts like a taxpayer’.
And now we’ve just come out of a general election debate that has once again confirmed a fundamental consensus between citizens of this country. On the unique importance of the NHS to the life of our nation. And as the embodiment of the promises we make to each other, across the generations.
So we have a plan, and we have backing for it. Founded on national pride in what the NHS represents. Tempered by the reality of current pressures on services. Propelled by an optimism that amazing medical advances lie within reach.
But to succeed over the coming five years we’re going to need a new partnership between the public, the government and the health service. So today here in the West Midlands let’s be clear about what this’ll take.
It means concrete, comprehensive, and sometimes controversial action on three broad fronts.
First, as a nation it’s time to get our act together on prevention.
Yes, life expectancy is its highest ever. But smoking still explains half the inequality in life expectancy between rich and poor – and two thirds of smokers get hooked as kids. Binge drinking costs at least £5 billion a year – in A&E admissions, road accidents, extra policing. Junk food, sugary fizzy drinks and couch potato lifestyles are normalising obesity – and as parents, a third of us can’t now spot when our own child is seriously overweight.
So we’ve got a choice. Condemn our children to a rising tide of avoidable diabetes, cardiovascular disease, cancer? And burden taxpayers with an NHS bill far exceeding an extra £8 billion by 2020? Or take wide-ranging action – as families, as the health service, as government, as industry. Using the full range of tools at our disposal.
It’s a no brainer – pull out all the stops on prevention, or face the music.
So the second of our mission-critical tasks over the next five years is fundamental redesign of how services are provided. Blurring the old boundaries between GP and hospital care, physical and mental health services, health and social care.
And one of the best ways of getting this personalisation and integration will be to give patients and their families more clout over the support they receive. If the NHS is a cradle to grave service, let’s give pregnant mums real choices about safe birthing options. Let’s ensure that people who die in hospital can do so at home if they prefer. And that for the parent whose child becomes sick on a Sunday, we’ve a more integrated seven day service, ending confusion about whether to call the GP, or 111 or 999, or go to A&E.
Six weeks ago we got going on redesigning care in 29 areas across England, covering five million patients. This morning I took the Prime Minister to see what it means here in the West Midlands.
So prevention and care redesign – over time they’ll both help with our third major challenge which is putting the NHS’ finances on a sustainable footing. But they’re not a quick fix, and they won’t be enough.
Even then – just like every health service around the world – with a growing population and an aging population we’re going to need more funding, year by year, not just in 2020.
We’ve said at least £8 billion a year in real terms by the end of the decade. But precisely how much, and with what phasing, will partly depend on how radical and how successful we are on prevention, on care redesign, and on our broader efficiency programme. And we’ll need careful and disciplined phasing of our ambition to expand services – be it improved cancer care, mental health, primary care, seven-day services – all of which we want to do.
None of this will be easy. In fact the Health Service is entering probably the most challenging period in its 67-year history.
We’ll certainly step up and play our part – but the NHS can’t do it alone. Because the NHS isn’t just a care and repair service, it’s a social movement. We’re going to need active support from patients, the public, and politicians of all parties. Support that we’re optimistic about getting.
Because there’s no nobler ambition, no higher calling, than advancing the health and supporting the wellbeing of all families, and all communities, across the length and breadth of this country.”
In a major new initiative designed to tackle the challenges set out in the Five Year Forward View, NHS England has announced 29 ‘vanguard’ sites across England that will take the lead in transforming standards of patient care.
From April 2015, the vanguards – which involve nurses, doctors and other health and social care staff – will redesign care in their areas and unite home care, mental health and community nursing, GP services and hospitals for the first time since 1948.
“The first wave of vanguard sites represents a practical start to transforming the NHS”, said David Bennett, chief executive of Monitor. “We will use our expertise in areas such as pricing and system economics, alongside our oversight of foundation trusts, to help local areas develop the new models of care that are essential for the NHS and the people who use it.”
According to NHS England, the vanguards will take the national lead on the development of: (i) multispecialty community providers (MCPs) – moving specialist care out of hospitals into the community; (ii) integrated primary and acute care systems (PACS) – joining up GP, hospital, community and mental health services; and (iii) models of enhanced health in care homes – offering older people better, joined up health, care and rehabilitation services.
“The NHS now has its own long term plan, backed by just about everybody, and today we’re firing the starting gun”, said Simon Stevens, NHS England chief executive. “Instead of the usual top-down administrative tinkering, we’re backing radical care redesign by frontline nurses, doctors and other staff – in partnership with their patients and local communities. From Wakefield to Whitstable, and Yeovil to Harrogate, we’re going to see distinctive solutions to shared challenges, which the whole of the NHS will be able to learn from. ”