The plan is a commendable step forward, but misses some of the most fundamental barriers to change
We are reliably informed that NHS England (“NHSE”) has “evolved in three distinct phases” since it was established.
This latest phase should be welcomed by the general public, any refocus and prioritisation on delivery, as opposed to the obsession with restructures and writing strategies, has to be good for those that want to see a modernised health service come into being.
However, CCGs will be up against it as the latest update to the 5YFV (Next Steps on the NHS Five Year Forward View) to heap on the pressure. In reality, it will not be NHSE that do the actual delivery, or need to make local health systems work in a way that delivers against the separate objectives for Urgent Care, Cancer, Mental Health, and Integration, it will be local CCGs and their providers. In addition, CCGs and their providers will be held accountable for meeting local control totals.
The growing accountability of CCGs since their establishment in 2013 (including increased commissioning responsibilities for primary care and specialised services) is becoming starker. In the 5YFV “next steps” it is made very clear who now holds responsibility for the NHS budget at a local and regional level:
“CCGs missing their financial goals will lose access to the CCG Quality Premium. Trusts and CCGs missing their individual (or, where applicable, system) control totals may be placed in the Special Measures regime. CCGs in that status will be subject to legal directions and possible dissolution.” (Next Steps on the NHS Five Year Forward View)
Recent Sustainability and Transformation Plans have highlighted (much like Better Care Fund plans before them) a distinct gap between strategic ambition and the operational realities on the front line, as missed A&E targets sadly demonstrate. NHSE is aware of this, as the latest update to the 5YFV notches up the pressure for CCGs to start meeting the objectives they have committed to in their strategies. However, there is little recognition in the 5YFV of what it will take to get this done.
CCGs will require support to build the mature relationships required with Trusts and other key partners such as primary care, and social care within Local Authorities, if they are going to be able to deliver the expectations set out in the 5YFV over the remaining two years. NHSE will need to approach their support for local delivery in a more sophisticated way than simply demanding, and then publicly shaming CCGs and Trusts that fail to deliver, and will need to recognise many are starting from very different financial positions.
Chris Ham, Chief Executive at the Kings Fund sums it up well:
“Getting back on track in delivering key targets for patient care and balancing budgets are huge challenges. Transforming services at the same time adds to these challenges. With almost no growth in the NHS budget from next year, the government will need to revisit the NHS funding settlement to deliver the commitments set out in this plan”. (Welcoming NHS England’s Next steps on the Five Year Forward View)