1. health and fitness

THE NEW PARLIAMENT
UNDERSTANDING THE NHS CHALLENGE
The NHS loomed large in the recent General Election, with all political parties confirming its importance.
Nevertheless, the health service faces unprecedented challenges, not just this year but throughout the
coming parliament.
The new Government needs to make early progress in addressing these challenges, and with that in mind JMC
Partners assembled a range of health experts in the months before the Election to discuss what’s required.
The breakfast sessions showcased some of the opportunities that exist to transform the way in which healthcare
is delivered, using new models of care supported by innovative technologies. However, the first and the last
sessions were dominated by the subject of money and the need for substantial additional investment to maintain
current services.
The new Parliament is therefore likely to face an invidious choice between increasing funding or cutting the
NHS coat to fit the available cloth. Efficiencies are to be had and must be secured, but these will not provide a
substitute for hard choices. Indeed, in some cases new models of care will throw up hard choices of their own,
for example around the sanctity of local hospitals.
PRE-ELECTION JMC BREAKFAST EVENTS: TOPIC OVERVIEW
money
commissioning
provision
Summaries of each event are provided overleaf
MAINTAINING THE NHS: RECOMMENDATIONS TO THE NEW PARLIAMENT
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xpectations need to be set: increasing demand for services and limited budget rises mean that it is important to be realistic about what
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the NHS can deliver. Even if funding increases in line with current pledges, will the NHS still be able to deliver the services that the public
has come to expect? A frank discussion is needed.
dditional investment needs to be adequate: polling data from the Health Foundation ahead of the election suggested that 59% of the
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public would be willing to pay more taxes to fund the NHS. Should the government consult on how it will raise additional funds for the NHS?
The scale of the challenge is clear: to maintain the services we have come to expect, substantial extra funding is required.
onger-term budgets are required to drive change: speakers and attendees at the events were unanimous that one year budgets
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do not support transformation and are holding back reform. Will the Treasury consider allowing three or five year budgets for the
NHS? New models of care will require additional investment and any savings delivered are unlikely to be seen in the short term –
a realistic approach is essential.
ross-party collaboration is crucial: the NHS must no longer be used as a political football. A grown-up discussion based on facts
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will enhance the chances of a sustainable NHS for the future. Politicians across the political spectrum should be prepared to stand
up for and be counted on the need for change.
money
commissioning
provision
FINANCIAL SUSTAINABILITY
COMMISSIONING DEVELOPMENTS
NHS PROVISION IN NUMBERS
n The percentage of NHS trusts and foundation trusts in
n Primary care co-commissioning: from 1st April 2015,
n The NHS provider sector accounts for £65 billion of the
deficit increased from 10% in 2012/13 to 26% in 2013/14
n A £2.1 billion surplus across the NHS in 2012/13 was
reduced to £722 million in 2013/14, there is very little
leeway remaining when it comes to NHS budgets
n Recent reports reveal a £1.6 billion deficit among NHS
providers for 2014/15, £750 million of which is a repayable
loan from the Department of Health. Predictions for 2015/16
suggest that the overall deficit could reach £2.3 billion
SPEAKERS
Rt Hon Margaret Hodge MP, Chair, Public Accounts
Committee, Richard Murray, Director of Policy,
The King’s Fund & Crispin Dowler, Senior
Correspondent, Health Service Journal
Date: 25th November 2014
KEY TOPICS
n The NHS faces significant financial challenges. The
£30 billion funding gap and its potential impact on the
quality of NHS care is alarming
n Evidence suggests that NHS institutions’ financial
the majority of CCGs took on fully delegated or joint
commissioning responsibility for primary care, designed
to allow CCGs to manage local services better
n Models of care within the Five Year Forward View:
29 vanguard sites have been identified to take forward
the models of care set out in the Forward View, seeking
greater integration between primary care, secondary care
and community services to support personalised and
coordinated health services
n Devo Manc: a memorandum of understanding was agreed
in February 2015 stating that the £6 billion health budget
for Greater Manchester would be devolved to local councils
and commissioners, merging health and social care for
2.7 million people. Details about the changes are still
emerging and may require new legislation
n Specialised services collaborative commissioning:
NHS England has proposed much greater collaboration
with CCGs on specialised services commissioning. Although
it will retain budget and responsibility for specialised
services in 2015/16, NHS England has not clarified who
will hold responsibility in future
position is deteriorating
n Financial challenges appear to be having an impact on
service delivery and performance against key targets
n Five Year Forward View (5YFV) funding scenarios
prompted funding pledges from the political parties.
However, concerns have been raised that these pledges
will not be sufficient, as they rely on the NHS delivering
ambitious savings in the face of increasing demand
SPEAKERS
Dr Amanda Doyle CBE, Chief Clinical Officer,
NHS Blackpool CCG and Co-Chair, NHS Clinical
Commissioners, Jeremy Taylor, Chief Executive, National
Voices & Lord Warner, Chair, Social Care Funding
Commission and former Health Minister
Date: 14th January 2015
KEY TOPICS
n Leadership provided by Simon Stevens within NHS
England and by clinical members within CCGs is
important to support improvements within the NHS
n Preventing overspill from social problems into the health
service should be a priority. The £5.8 billion Better Care
Fund has positive aspirations to join up services but these
may be too ambitious to deliver with the available funds
n Formally merging budgets may be dependent on
£113 billion NHS budget
n There are 244 NHS providers, consisting of 147 Foundation
Trusts and 97 NHS Trusts across acute, integrated, specialist,
community, mental health and ambulance services
n Acute hospital care consumes almost half of the entire
NHS budget
n 88% of providers opted for NHS England and Monitor’s
Enhanced Tariff Option (ETO) following the rejection of
the 2015/16 tariff proposals
SPEAKERS
Bob Bell, Chief Executive, The Royal Brompton and
Harefield NHS Foundation Trust, Chris Hopson, Chief
Executive, NHS Providers & Professor Sir Julian Le
Grand, Richard Titmuss Professor of Social Policy, LSE
Date: 4th March 2015
KEY TOPICS
n Modest increases in funding along with a growing
population had meant that spending per person has
decreased each year of the last parliament
n NHS providers need stability to stop the deterioration
of finances and maintain high performance. To do this,
clear expectations of the provider sector need to be set
n Maintaining high quality services is dependent on
achieving the right balance of choice and competition,
regulation and patient outcomes assessments
n Improving the state of poorly performing institutions is
a particular challenge
n Transformation is essential but this requires upfront
investment to support double running of services.
There was scepticism about how the 5YFV aims would
be delivered based on current financial projections
n Recent tariff negotiations have shown that the
obligation on commissioners to manage a balanced
budget has a significant impact on NHS providers,
pushing even more trusts into the red
legislative change, which could further disrupt the
health service. Piecemeal change through vanguard
sites and “earned autonomy” arrangements is likely to
be the preferred route for reform
n Poor A&E performance was highlighted as a particular
area of concern (a “hot topic” as the event took place
at the height of winter pressures)
n There was significant support for introducing three to five
year budgets to support more strategic commissioning
with a greater focus on prevention and transformation
JMC Partners is an award-winning policy communications consultancy, with a particular expertise in
healthcare. We have a proven record of informing and influencing public policy on behalf of our clients.
For more information about our work, please contact [email protected].
These events were held without client sponsorship. A charitable donation was made to the Newman
Holiday Trust in lieu of speaker fees.
OUR AWARDS
Communiqué Awards 2014
Finalist Specialist Consultancy of the Year
Communiqué Awards 2013
Winner Small Consultancy of the Year
Communiqué Awards 2012
Winner Best Healthcare Policy Programme