Business > Efficiency

NHS England chief addresses Brexit and integrated care challenges

Neil Merrett Published 19 July 2016

Simon Stevens expects funding for localised technology and service integration plans to be finalised by October; says it is too early to determine financial impact from referendum


NHS England Chief Executive Simon Stevens expects the majority of 44 Sustainability and Transformation Plans (STPs) setting out how authorities hope to meet the aims of the Five Year Forward View plan will be “well designed” as they are reviewed over the next two months.

The 'Five Year Forward View' plan functions as a blue print for closer integration of health and social care through technology and data systems, with the STPs – currently expected to be signed off in October - providing more strategic direction on the exact deliverables.

Speaking to the House of Commons Health Committee today, Stevens spoke on a number of issues including financial sustainability, the importance of NHS infrastructure and integrated care investment, as well as how it was still too early to discuss the exact impacts of Brexit on funding.

Stevens was asked to clarify how many of the 44 STP footprint areas were “well advanced” in setting out objectives for more technology-led integrated care.

In response, NHS England’s chief executive said that a clearer picture was expected to be known from early next year. 

“I think the majority of the country will have well designed service improvement and change plans that [NHS England] will be able to back come October.  In terms of the timetable. they have got to get financial modelling done by mid-September, October is when we are looking to sign off on the plans,” he said.

Stevens said there was anticipated to be some variation between the 44 plans it received, noting that some areas will have worked together for a longer time and have a more articulated approach on locally implementing the Five Year Forward View.

“On the other end of the spectrum, there are some people, frankly, for whom this is the first time they have really been sharing their views together locally on how services need to change and they have a further path to tread,” he said.

“I think one of the very positive elements of how these conversations are developing is that local authorities and local government leaders are much more involved in the way what health and social care integration should look like in their area giving the funding envelope.”

Stevens claimed that in order to support work transformation plans, NHS England has also decided to bring forward the annual NHS commissioning funding cycle for a two year period. This was expected to finalise funding up to 2018/2019 by Christmas 2016.  As a result, authorities were expected to begin undertaking their transformation plans by late January next year.

Questioned specifically around the capital funding requests likely to arise through the STP process, he told the committee there would be a process of having to prioritise needs between the backlog of buildings needing renovation, investment to free up efficiency savings and funding for technology to drive the wider digital agenda.

“We’re having to rank where we either have a mission critical need to do some repairs due to Care Quality Commission (CQC) or a health and safety issues on the one hand, and on the other, for those where it is a service redesign issue, we will have to rank them on how ready they are and how much of a payback they gave us,” he said.

Stevens argued that from his personal view, it would be an ideal moment to consider an “upgrade in NHS infrastructure”.

He added that initial STPs had been unrealistic in terms of the likely funding they would receive out of a proposed £4bn in spending to be made to individual areas to support healthcare innovation.

“The idea you can get kind of £1bn for one of the 44 [areas] is for the birds.  So somewhere between ‘not very much’ and ‘more than we’ve got’ is probably a sensible compromise,” added Stevens about how best to budget for the STPs.

Asked how funding challenges may constrain more ambitious innovation plans around trying to expand integrated care services, NHS England’s chief executive said there was a shared sense of working between local authorities and health care providers that was starting to overcome more siloed organisational thinking.

This could include adopting shared governance or accountability models between different organisations.

Stevens was also questioned around the potential impacts of the EU referendum result on UK healthcare and the sector’s wider technology transformation ambitions.

With the UK having voted in favour of leaving the EU, Stevens said it was still too early to say how funding commitments would be impacted, particularly with regard to high profile campaign pledges around potentially providing an additional £350m a week to fund healthcare upon exiting the EU.

He confirmed that he had no indication from the government about any additional funding such as the mooted figure from some ‘Vote Leave’ campaigners now in the Cabinet that would be made available for the NHS.

“I think there were different versions of that promise. There was certainly a very clear and dated commitment to make available to the NHS an extra £100m extra by 2020, the £350m I don’t think ever had a precise date attached to it. But the £100m a week by 2020 did.”

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