Agenda item

Carol Stubley, NHS England, to present

Carol Stubley, NHS England, presented the NHS 5 Year Forward View:-

 

The NHS have achieved a lot

-          Currently #1 healthcare system in the world

-          More than 2/3 UK public believe the NHS “works well”

-          Cancer survival is at its highest ever

-          Operation waiting lists are down – many from 18 months to 18 weeks

-          Early deaths from heart disease are down over 40%

-          160,000 more nurses, doctors and other clinicians

-          Single sex wards implemented

 

We are delivering more care – compared with 2009 the NHS is delivering more care

-          4,000 more people are being seen in A&E each day

-          3,000 more people are being admitted to hospital each day

-          22,000 more people have outpatient appointments each day

-          10,000 more tests are performed each day

-          17,000 more people are seeing a dentist each day

-          3,000 more people are having their eyes tested each day

 

Demand for care is rapidly growing

-          We are facing a rising burden of avoidable illness across England from unhealthy lifestyles:

1 in 5 adults still smoke

1/3 of people drink too much alcohol

More than 6/10 men and 5/10 women are overweight or obese

-          Furthermore:

70% of the NHS budget is now spent on long term conditions

People’s expectations are also changing

 

There are also new opportunities

-          New technologies and treatments

Improving our ability to predict, diagnose and treat disease

Keeping people alive longer

But resulting in more people living with long term conditions

-          New ways to deliver care

Dissolving traditional boundaries in how care is delivered

Improving the co-ordination of care around patients

Improving outcomes and quality

-          The financial challenge remains with the gap in 2020/21 previously at £30bn by NHS England, Monitor and Independent think-tanks

 

The future NHS – the Forward View identifies three ‘gaps’ that must be addressed:-

-          Health and Wellbeing

Radical upgrade in prevention

Back national action on major health risks

Targeted prevention initiatives e.g. diabetes

Much greater patient control

Harnessing the ‘renewable energy’ of communities

-          Care and Quality

New models of care

Neither ‘one size fits all’ nor ‘thousand flowers’

A menu of care models for local areas to consider

Investment and flexibilities to support implementation of new care models

-          Funding

Implementation of these care models and other actions could deliver significant efficiency gains

However, there remains an additional funding requirement for the next Government

Need for upfront pump-priming investment

 

Getting serious about Prevention

-          Focusing on Prevention

Incentivise healthier individual behaviours

Strengthen powers for local authorities

Targeted prevention programmes starting with diabetes

Additional support people to get and stay in employment

Create healthier workplaces – starting with the NHS

-          Empowering Patients

Improve information: personal access to integrated records

Investment in self-management

Support patient choice

Increase patient control including through Integrated Personal Commissioning (IPC)

-          Engaging Communities

Support England’s 5.5m carers – particularly the vulnerable

Supporting the development of new volunteering programmes

Finding new ways to engage and commission the voluntary sector

NHS reflecting local diversity as an employer

 

Developing new Care Models

-          We need to take decisive steps to transition towards better care models

-          There is wide consensus that new care models need to:-

Manage systems (networks of care) not just organisations

Deliver more care out of hospital

Integrate services around the patient

Learn faster from the best examples around the world

Evaluate success of new models to ensure value for money

-          There are already examples of where the NHS is doing elements of this

-          However, cases are too few and too isolated

-          The answer is not ‘one size fits all’ nor is it ‘a thousand flowers bloom’

-          We will work with local health economies to consider new options that provide a viable way forward for them and their communities

 

New deal for Primary Care

-          Funding

       Stabilise core funding for two years and increase investment in the sector over the next Parliament

       New funding for schemes such as the Challenge Fund

       New infrastructure investment

-          Commissioning

       Increase CCG influence over commission of primary care and specialised services

       New incentives to tackle inequalities

-          Workforce

       Increase the number of GPs in training

       Train more community nurses and other primary care staff

       Invest in new roles, return and retention

-          Public Engagement

       Building the public’s understanding of pharmacies and on-line resources to reduce demand

 

Multi-Speciality Community Providers

-          What they are

       Greater scale and scope of services that dissolve traditional boundaries between primary and secondary care

       Targeted services for registered patients with complex ongoing needs (e.g. the frail elderly or those with chronic conditions)

       Expanded primary care leadership and new ways of offering care

       Making the most of digital technologies, new skills and roles

       Greater convenience for patients

-          How they could work

       Larger GP practices could bring in a wider range of skills – including hospital consultants, nurses and therapists, employed or as partners

       Shifting outpatient consultations and ambulatory care out of hospital

       Potential to own or run local community hospitals

       Delegated capitated budgets – including for Health and Social Care

       By addressing the barriers to change, enabling access to funding and maximising use of technology

 

Primary and Acute Care Systems

-          What they are

A new way of ‘vertically’ integrating services

Single organisations providing NHS list-based GP and hospital services, together with Mental Health and Community Care Services

In certain circumstances, an opportunity for hospitals to open their own GP surgeries with registered lists

Could be combined with ‘horizontal’ integration of social and care

-          How they could work

Increased flexibility for Foundation Trusts to utilise their surpluses and investment to kick-start the expansion of Primary Care

Contractual changes to enable hospitals to provide Primary Care Services in some circumstances

At their most radical they could take accountability for all health needs for a register list – similar to Accountable Care Organisations

 

Other New Care Models

-          Urgent and Emergency Care Networks

Simpler and better organised systems achieved by

·           Developing networks of linked hospitals to ensure access to specialist care

·           Ensuring 7 day access to care where it makes a clinical difference to outcomes

·           Proper funding and integration of Mental Health Crisis Services

·           Strengthening clinical triage and advice

-          Specialised Care

Consolidating services where there is good evidence that greater patient volumes lead to greater quality

Working with a smaller group of lead providers willing to take responsibility for developing geographical networks of specialised and non-specialised care

Moving towards specialised centres of excellence for rare diseases

-          Viable Smaller Hospitals

Help sustain local hospital services where:

·           They are the best clinical solutions

·           They are affordable

·           They have commissioner support

·           They have local community support

·           Consider adjustments to payment mechanisms

·           Explore new staffing models

·           New organisation model including sharing management across sites, satellite provision on smaller sites and Primary and Acute Care systems

-          Modern Maternity Services

Explore how to improve our current services and increase choice by:

·           Commissioning a review of future maternity units for Summer 2015

·           Ensure funding supports choice

·           Make it easier for midwives to set up services

-          Enhanced Health in Care Homes

Developing new models of in-reach support and services by:

·           Working in partnership with Social Services and care homes

·           Building on existing success

 

Implementing new Care Models

-          To deliver new care models we need a new type of partnership between national bodies and local leaders

-          Working with local communities and leaders, NHS national bodies will jointly develop:

Detailed prototyping of new care models

A shared methodology for assessing the characteristics of health economies

National and regional expertise and support for implementation at pace

National flexibilities in current regulatory, funding and pricing regimes

A new investment model to help ‘pump prime’ and fast track the new care models

 

Delivering Innovation and Change

To deliver the scale and pace of change required we will also take steps to

-          Align NHS Leadership

-          Develop a modern workforce

-          Exploit the Information Revolution

-          Accelerate innovation

 

Efficiency and Funding

-          It has previously been calculated that the NHS faces a gap between expected demand and funding of -£30bn by 2020/21

-          To address this gap we will need to take action on 3 fronts: demand, efficiency and funding.  Less impact on any 1 of these will require compensating action on the other 2

-          Delivery of the more active demand and prevention activities outlined in the Forward View would deliver in the short (e.g. prevention of alcohol harm) and medium term (e.g. action on diabetes)

-          The long run efficiency performance of the NHS has been -0.8% annually.  We have achieved nearer 2% more recently although this has been based on some actions that are not indefinitely repeatable e.g. pay restraint

-          However, with upfront investment and implementation of new care models, we believe that we could achieve 2% rising to 3% over the next Parliament

-          Combined with an increase in funding equivalent to flat-real per person (e.g. adjusted for population growth and age) - about £8bn more – would close the gap

 

Next Steps

-          NHS England is now embarking on work with other NHS national bodies and wider stakeholders to implement the commitments in the Forward View

 

Discussion ensued with the following issues raised/clarified:-

 

·           People were living longer but an increasing number of people with long term conditions

·         Ever increasing number of people that needed access to services because of lifestyle factors e.g. alcohol, obesity, lack of exercise

·         Culture of change required and for people to take more responsibility for their personal health and lifestyle choice

·         Need to be more innovative and creative in terms of creating care models locally reflecting the needs of the local population

·         Still expectation that will deliver 3% savings every year for the next 5 years whilst recognising need for upfront investment and double running costs to be incurred

·         £8Bn expected funding gap identified

·         2015/16 was the first year of the Plan – guidance would be published by NHS England on 23^rd December

·         Difference in opinion as to whether the changes to the funding formula was thought to have a negative effect for Rotherham

·         Funding and framework was required to allow patients to be empowered to make their own choices and self-management as well as the vulnerable members of society requiring advocates to access the services

·         Although the document was welcomed, the CCG was concerned about the risk to Rotherham with regard to the new formula

 

Resolved:-  That the report be noted.