The big news at this year’s gathering of the NHS Confederation at Liverpool’s docks was the announcement by NHS England chief executive Simon Stevens of the massive intervention in the three failing health economies of north Cumbria, Essex and northern, eastern and western Devon.
Western Devon’s clinical commissioning group is already predicting a deficit this year of almost £80m.
By way of justification Stevens pointed out that every other approach – such as firing chief executives and providing short-term bailouts – has been tested to destruction in these areas. While the euphemistically titled “success regime” has been discussed for some time, the scale and intensity of it marked a significant ramping up of NHS England’s use of hard power. This was not creating the conditions for success, but a wholesale takeover by NHS England of a significant chunk of the health service. It felt like the sort of thing his predecessor, Sir David Nicholson, would have done.
This will make the central bodies – and to a significant degree, Stevens personally – responsible for redesigning services in areas with sometimes decades of poor performance. The implication is that if this intervention doesn’t sort them out, then the NHS has run out of ideas on how to turn round system failure.
In the aftermath of the announcement, conference delegates started talking about the return of the strategic health authority, and tough questions were posed about the readiness of the central bodies to manage the task.
Stevens betrayed a growing intolerance towards individuals and institutions that underperform and waste money, singling out staff responsible for unwarranted clinical variation and organisations that refuse to collaborate. He also criticised the performance of some clinical commissioning groups for unrealistic funding of acute care.
His speeches are increasingly peppered with references to collective action, on everything from procurement to financial planning. But he emphasised the importance of not falling into the trap of thinking it’s all about the money – on the contrary, it’s about designing patient-centred care.
Alongside the intervention announcement, the most significant part of Stevens’ speech was his attack on the growing tide of childhood obesity. He knows that however successful his efficiency drive and his vanguard programme for redesigning services, it all risks being overwhelmed by a huge escalation of avoidable illness – notably type 2 diabetes.
In a question and answer session the following day, he indicated he has a “game plan” for how he is going to change the terms of the national debate on prevention and good health, with hints of a tough line on the food industry. Stevens’ ability to get families and ministers to face up to the profound decisions they need to take will be at least as important as any reforms he delivers in the NHS.
Unintentionally the most amusing session of the conference was the joint appearance by the six men leading the national bodies. It was a masterly demonstration of the absence of personal chemistry between them, and he living embodiment of the fragmentation of the commanding heights of the NHS wrought by the coalition’s reforms.
The health secretary, Jeremy Hunt, showed the value of ministerial appointments having continuity, with a speech that demonstrated his firm grasp of the brief. He used the inspiring example of Virginia Mason Medical Center in Seattle to push his message that financial efficiency is the route to high quality care, not the alternative to it. Afterwards, a senior figure in NHS reform could be heard muttering that if Hunt thought Virginia Mason was so impressive, it was a pity he had sacked everyone who knew about it.
But neither Hunt’s speech, nor any of the others, convinced delegates that there is a solution to the NHS’s funding problems. There is an air of incredulity about the prospect of reaching the required £22bn of efficiency savings when providers are running up collective deficits of hundreds of millions of pounds.
