Introduction to the NHS Providers Annual Conference 2019: The current provider landscape - Hot topics and issues facing our members Speaker: Mark Stevenson, Chief Operating Officer, NHS Providers
About NHS Providers
NHS PROVIDERS STRATEGIC POLICY UPDATE September 2019
The big five System architecture Politics / external Performance : ever Money : 19/20 Workforce : People / regulation / New Government: increasing demand revenue looks on plan planning: initial honeymoon causing real worries track; 19/20 capital implementation Collaborative leads to division and around urgent and cut reversed; strong beginning to gather controversy. NHS emergency care working continues current focus on pace but pressures helpfully top of list performance and at pace and brings designing future still universal and of domestic risk of winter / flu / opportunities but financial will take time to priorities. No deal no deal Brexit triple also challenges, esp. architecture solve threat looms. whammy in social care.
An uncertain autumn ahead General election? • Summer focus on Brexit, NHS, education & justice – getting on an election footing? • Lead in the polls (taking back support from the Brexit party) but a lot of polling volatility •Queen’s speech on 14 October Make hay whilst the sun shines •“Fill the grid” with NHS announcements •Capital, pensions, Health Education England budget increase…… hospital food….. migrant cost recovery…… Extended series of fiscal events • One-year revenue-focused spending review took place on 4 September; Emergency Budget expected November; CSR next year No deal Brexit on the cards? • NHS and wider no deal preparations stepped up • Five week prorogation of Parliament
The Long Term Plan - The NHS is changing! FROM TO • • Ruthless focus on small basket Much broader range of priorities beyond of centrally set priorities: small acute access targets: mental health, number of acute metrics, CQC integrated care, joining up primary care rating and financial surplus and community services; population health • • Focus on individual institutions Local health and care system working • • Heavy top down performance Multi year strategic planning • management / oversight Four tiers: national, regional, STP / ICS, • Focus on one year individual organisation • organisational plans Vertical and horizontal collaboration • • Regulatory intervention if Culture of learning, support, improvement performance slips vs plan and staff empowerment • • Purchaser / provider split Changed behaviours to support above
System working latest • Clear focus on finalising five year strategic plans… …despite gaps in information . Risks becoming a protracted process if plans need to be re- opened. • A period of considerable change: Ambition all STPs become ICSs by 2021 CCG consolidation at pace Emergence of Primary Care Networks at the neighbourhood level
New government’s £1.8bn capital boost • £1bn increase to CDEL for 2019/20 – reverses planned 20% cut • Most will come from provider reserves – but is still additional spending power not otherwise available • £850m of improvements for 20 trusts across several years also approved • Government signals it will prioritise NHS and infrastructure
Trust unable to recover performance • A&E: Highest number of A&E attendances ever in July – 4% higher than July last year • RTT: Elective care waiting list is now 4.4 million – it increased by 10,000 since the previous month • Cancer : Missing 3 key targets – 2 week urgent referral (90%), 31 day (95.96%), 62 day wait (76.7%) • Diagnostics: 3.8% of patients waiting six weeks or longer from referral, missing the 1% target • Mental health: 795 out of area mental health placements – 19% increase on last year • Ambulances: Missing the Category 1 and category 2 average response times
The run up to winter 2019/20 • Tough summer with no bounce back in performance • Brexit – no deal exit on 31 October? • Potential bad flu season ahead • Trusts piloting new standards • Pensions adding to workforce pressures • Ongoing capital constraints • No NHS winter money expected
Last winter This winter ‘Winter’ pressures – what does the provider sector need? • • Better preparation Starting in an even • Improving local more challenging relationships position • • Flu less prevalent Capacity an issue for • Milder weather almost everyone • • Increase in Even bigger push on respiratory conditions flu immunisation • Successful reduction expected • in length of stay, Independent sector ambulance handover expected to help with delays, 12 hour waits elective • Extra money for care/diagnostics • some trusts, but very Concern about staff rushed wellbeing with all • Fewer interventions year round pressures from the centre
NHS People Plan • Working from interim plan to final framework – early stages of working group activity • NHSI/E workforce directorate coming together quickly under Prerana Issar • Multiple subgroups operating – our main focus on: Leadership and culture, including Kark Review, central-local compact Workforce architecture and “new operating model” Best place to work priorities, including new staff offer and review of HR practice • Advisory group providing inclusive environment, gradual progress • December / January publication the target
Our view – ongoing workforce challenges Vacancies are clearly impacting performance , particularly in A&E, while rural trusts are looking at an increasingly difficult recruitment picture Staff burnout has reached a critical point and it’s clear we need to do more to improve the NHS employment offer. A focus on culture, inclusion and diversity will only increase in emphasis Creating the right “new operating model” will be challenging. Workforce responsibilities need to be devolved at the right place and pace; new system implementation plans will be key; and there’s a risk of a zero sum game with PCNs Training new and current staff – trusts are finding it difficult to invest in training and uncertainty remains around the medium-term workforce development budget
Clinical review of standards – where are we now? • Trust pilot sites for new A&E, RTT and cancer standards all announced • Testing began during summer 2019 • Clinical Standards Oversight Group convened • Waiting for mental health sites to be announced • NHS England is commissioning an independent evaluation • Six local Healthwatch sites looking at the impact of the new urgent & emergency care standards Concerns: 1. Will timeframes, targets and trajectories be realistic? 2. Has engagement with public been realistic? 3. What support will be offered to trusts to implement new standards?
An evolving NHSE/I Seven NHSE/I Regional Directors Phase three staff consultation on proposed NHSE/I restructure closed 29 August Regional teams establishing ways of working with providers and commissioners Moving to new ways of working and a coalition for change?
NHS Providers activity Over the summer… Coming up… Big push on capital – Campaigns: capital and winter #RebuildOurNHS including a briefing and the launch of winterwatch Big push on pensions – including briefing on local Roundtables: on pensions, schemes financial architecture and the Kark review On the day briefings – ICP contract, oversight framework, New reference group: On mental health implementation subsidiary companies framework, prevention green Briefings: on clinical review of paper, new government standards, dual chairs and Reports: regulation survey winter report, Primary care networks: a Reports: State of the NHS quiet revolution (with Confed) provider sector report; Providers Deliver
Overview of Programme and member priorities Speaker: Mark Stevenson, Chief Operating Officer, NHS Providers
Ambition to Reality • This is a policy led event – our members chance to discuss current and future hot topics • This year we are exploring how members are embracing new opportunities to: • Recover performance • Stabilise finances • Invest to transform • Work with partners
The big issues What are the challenges? What are the solutions? • Increasing demand • System working and population • Workforce shortages and pressures health management • Constrained finances • Innovation to redesign processes , • Backlog of infrastructure issues free up time and cash and improve • Outdated practices and ways of patient experiences • Staff retention, deployment, working efficiency • Efficiency savings
Plenary Sessions • Leading and embedding a compassionate, inclusive and collaborative culture • Transforming patient care and experience through digital transformation • Playing a critical role in prevention and early intervention • Plus Matt Hancock, SoS and Simon Stevens, CEO NHS England • Farewell from our retiring Chair
Breakout strand 1 • Focus on sustainable quality improvement • Embedding improvement to deliver lasting change in the care of patients and service users • Embedding a culture of improvement • Journey’s from ‘requires improvement’ to ‘good’ • TBC
Recommend
More recommend
