29 March 2018

NHS in the spotlight - highlights week ending 29 March 2018

This week has seen the NHS in the spotlight recently with the publication of the Public Accounts Committee report on NHS sustainability and transformation, Prime Minister’s answers to the Liaison Committee,  Simons Stevens at  the Health Select Committee, and the NHS England Board meeting outlining the ongoing work to integrate NHS England and NHS Improvement.

Simons Stevens at  the Health Select Committee 20 March 2018
Talking to the Health  Social Care Select COmmittee on Integrated Care : organisations, partnerships and systems Simon Stevens described the changes behind integrated services as increasing need generated by LTCs, services based on reactive not anticipatory care and the need for change from a paternalistic attitude by the NHS to one where patients take control of their care.

One of the impacts of the ACO contract (currently under consultation) described by Simon Stevens, and picked up by MPs was the fact that he expects the number of service procurements to reduce, as currently procured services are brought into the integrated service. These services will then not be open to regular reprocurement. It was stressed that integrated services are not new organisations but still part of the NHS. The current draft contract does not allow dilution of NHS T&C. There is no change to statutory accountability as laid out in current legislation. “CCGs will still be there.”

Potential benefits of ACOs include reducing complexity, smoothing funding flows and relationships between primary, community and acute services. GP willingness to become involved is key to progress on integrated services. Where they are not willing to become involved integration is not viable. Simon Stevens does not see ACOs becoming mandatory.

Simon Stevens would not be drawn on funding required to fulfil NHS constitutional obligations or legislative changes he would like to see to support transformation of the NHS except around closer working between NHS I and NHSE, and needs of governance structures around future integrated care systems. There may be opportunities around changes to procurement law following Brexit which would support these systems.
(Also worth a  read - Chris Ham's blog A progress report on integrated care systems)

Public Accounts Committee report on NHS sustainability and transformation 27 March 2018
The bottom line of the HC PAC report  Sustainability and transformation in the NHS, is that Department of Health and Social Care (the Department), NHS England and NHS Improvement to stop thinking short term and start working together to make transformational changes. It describes an NHS "still in survival mode", using capital budget to fund short term needs rather than long term transformation.  

The Department have been asked to report back to the Committee on a number of issues: 
  • progress towards more stable long-term funding arrangements, 
  • action to tackle workforce issues, a strategy for addressing long-term structural problems in trusts, 
  • a review of how capital budgets are spent, outlining model guidance articulating how accountability will work under the new integrated care systems
  • guidance and evidence of how the NHS, local government and the voluntary sector can work more cohesively as a whole system, including communication and engagement with patients and 
  • work to promote new ways of working and examples of good practice by vanguards to all areas of the country.
Prime Minister’s answers to the Liaison Committee 27 March 2018
The PM’s comments at the Liaison committee on Tuesday (listen from 17.51) very much reflects the findings of the PAC report with the announcement of a new “sustainable long term plan” for the NHS based on “genuine cross party engagement” (but not a public commission as the Committee have called for).
NHS England Board meeting 29 March 2018
The Board meeting (papers available here) discussion included:
  • the draft contract for Accountable Care Organisations (ACO)s and published a series of FAQs arising from the public consultation;  
  • outcomes of the public consultation and subsequent Guidance for CCGs around over the counter (OTC) medicines which should not to be prescribed by GPs except in particular circumstances (eg vulnerable patients) and subsequent guidance which must be ratified by CCGs.
  • the impending integration of NHS England and NHS Improvement resulting in 7 Integrated Regional Teams; 
  • NHS England's responsibilities for quality and how they are put into action
  • Health inequalities overview paper and
  • NHS Financial report for 2017/18 to date which came with a rider regarding the lack of any system reserve for 2018/19 as funds were transferred to the Commissioner and Provider Sustainability Funds.