Simon Stevens Speech at NHS Confed 4 June 2014 Simon Stevens gave a speech at the NHS Confederation Annual Conference. As the new Chief Executive of the NHS the speech constituted his first significant outline of policy. This briefing provides a summary of the main points covered. A full transcript of is available here: http://www.england.nhs.uk/2014/06/04/simon-stevens-speech-confed/ Overview The focus of the speech was on how to “think like a patient, act like a taxpayer” in order to secure quality services that are good value for money. The primary goal must be on finding solutions for the future rather than analysing the challenges. Simon Stevens aimed to focus on the “big ticket” items to address over the next five years, based on 3 main aspects. 1. NHS commissioning for outcomes and value The main purpose of commissioners is to provide better value for money. In order to deliver better value for money the following will be worked on:
Test new reimbursement models for some elective conditions; An expansion of ‘year of care models’ for people with long term conditions; Alternative funding arrangements for emergency and urgent care; A review of how performance incentives (QOF, CQUIN, Quality Premium) are working; Steadily increase the proportion of [providers’] payments tied to performance, quality and outcomes; Different approaches to sharing utilisation risk for particular services along the spectrum, from volume-based payments at one end through to delegated capitated budgets at the other; Work with the Third Sector on new ways to commission services - for people with learning disabilities, with cancer, and with mental health problems, to begin with; A pragmatic look at the evolving division of labour between CCGs, CSUs and NHS England; Flexibly support new models where the commissioner/provider split is differently placed along the demand/supply continuum; Consideration to population-based virtual commissioning budgets that blend primary care, local hospital and community, and specialised services, as a basis for fairer allocations.
2. Redesigning care models a. Beds and Hospitals
Hospital beds are increasingly an anachronistic currency for assessing the quality of care. There will be need to remove beds and close hospitals, as there always has been. But there is also a pull for more local and community-orientated services. The primary focus is not on saving smaller district general hospitals, as reported in the Telegraph, but changing the way that community care is delivered. “We’re going to have to say that the division between what consultants do in hospitals [and] what GPs do in community settings, that is going to be dissolved.” Possibility of new multispecialty provider groups between GPs, community-based provider groups and social services. With delegated multiyear budgets to manage defined populations;
Many other ideas that should be available to local places, not through an NHS blueprint but through flexible and adaptable NHS. Changes in local areas need to be properly evaluated, with safeguards in place.
b. Specialised Commissioning
Some treatments are going to be further concentrated eg. Acute stroke services; Keith Willett plan to designate 40-70 major emergency centres still the plan of action; There is a need for a more realistic categorisation of specialised services - Although 175 service lines across 280 providers are now defined as ‘specialised’, just 76 providers account for 80% of the spending; NHSE will work with a smaller number of leading hospitals for some tertiary conditions on grounds of quality or efficiency.
c. The future workforce
More general physicians or ‘hospitalists’ working alongside consultant specialists. Together with advanced nurse practitioners, sessional GPs, and networked staffing arrangements with neighbouring trusts. This is linked to recommendations from the Royal College of Physicians Future Hospital Initiative. Not suggesting a wholesale reorganisation of medical training and staffing across England. However, medical training and staffing should not drive the wholesale reorganisation of district general hospitals across England.
3. Innovation and technology The NHS needs to embrace three fundamental shifts in the practice of modern medicine: a. Personalisation
As biology becomes an information science, we will see the wholesale reclassification of disease aetiologies; NHS England will be launching a competitive process for the nation’s leading teaching hospitals and clinical research centres to join the UK’s new 100,000 genome programme. ITT will be launched later in June. Also consulting on moving to a new model for regional genetics labs to upgrade and industrialise NHS capabilities in this area; The NHS has a unique combination of biomedical research, population-orientated primary and specialist care serving diverse patient groups, longitudinal data (to allow matching of phenotypes wit genotypes), an aligned financing system, and a rigorous focus on value creation.
There must be proper data linkage between GP systems and hospitals and other health care providers to create secure, confidential longitudinal information that allows us to target prevention and quality improvement, as well as help discover new treatments and cures.
c. Role of patients and communities
A focus on support for volunteering, unpaid carers, citizen’s assembly
What’s next for Strategic Planning? NHSE will provide a 5 year ‘Forward View’ in the autumn that will include a “more locally permissive policy and regulatory environment”. In July the next steps for local strategies will be set out.