In a keynote address to the King’s Fund’s annual care integration summit today, Simon Stevens made the case for a radical rethink of the way the NHS is organised and how funding flows into the system.
Part of this would be ditching some of the processes imposed on the frontline by national bodies.
“It’s time to call time on the foundation trust pipeline,” Stevens said.
“We are kidding ourselves if we think trusts are going to pass the criteria set out by Monitor. An awful lot of time is being spent mucking around on foundation pipelines.
“In my opinion it’s time to free up that time to focus on the population-oriented health systems we want to create across the country.”
He also said that the acquisition process, by which successful trusts take over struggling ones, was often “flawed” and time-consuming. There was need to call time on acquisitions as means of solving problems in the NHS in some parts of the country.
The upcoming November 25 Spending Review presented an opportunity for some fresh thinking on the NHS and shift away from a very transactional approach to health financing.
Stevens said there was a need to “change the defaults” on what the next five years look like. NHS England and NHS Improvement wanted to see local health economies define where they want to be by 2020 and draw up a plan to get there.
Admitting that national bodies were still finessing their thinking, Stevens suggested that instead of focusing on CCG allocations or tariff changes “we say here is the base case, but in order to get your share of the extra you’ve got to come together as commissioners, as providers, as communities to agree a shared sustainability and improvement plan”.
“It’s the agreement of that plan with a series of milestones that unleashes that extra funding,” he added.
He also revealed that three vanguards for cancer services would be testing a new approach to funding, which would move away from transactional payments for surgery, imaging and drugs towards payment for population-oriented improvements in cancer outcomes.
Cally Palmer, chief executive of the Royal Marsden NHS Foundation Trust, has been appointed national cancer director to lead this work.
Stevens also reflected on the NHS’s current financial problems. Figures released last week showed that the service ran a £930m deficit in the first three months of the financial year – £163m more than forecast.
Stevens said this was a result of an overspend on staffing and the £1bn transfer CCGs made to the local authorities as part of the Better Care Fund.
He said there was a need to get a grip on the situation. “If we lose control of our short term, we lose control of our finances, we lose control of our destiny.”
