News / HFMA 2014: Substantial challenges, despite extra funding, says Stevens

05 December 2014

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Image removed.He said the NHS was starting from the point of being one of the most efficient health services in the industrialised world. Despite this, there were three broad categories of opportunities for efficiencies.

The first was cost improvement over the next five years, identified by Deloitte as at least 5%. ‘Monitor and NHS England don't believe we can do that in one year so it will be phased in over the next
Parliament at 1% a year,’ he said.

There were opportunities to make patient flow through hospitals more efficient. Though some of the delays were due to forces outside hospitals’ control, most of the barriers were internal, he said. This included not having ward rounds on Sunday so patients would have to wait until Monday to be discharged.

A further 1.2% to 1.3% a year could be saved, according to Deloitte’s, from frontier shift – implementing better working practices and clinical techniques. The third was allocative efficiency offset – for example by reducing the 380,000 patients who have had a fall admitted as emergencies each year.

‘There is no doubt this is going to be a challenging period, but it will also potentially be a pivotal period. When we look back in three, five or seven years time, we may see that things that were previously off the table were put on the table,’ he added.

The NHS had made its pitch to the public for further funding in the forward view. He went through the forward view arguments – these included: NHS performance had progressed well over the last decade; doing more of the same was increasingly harder to sustain; and the fragmentation between primary and specialist care, and physical and mental health services had to end.

He said there were four main categories of local health economies or geographies. Some were working well and with the right flexibilities and support could adopt one of the new care models, such as the multispecialty community provider model. ‘In other cases small and medium-sized acute hospitals are having conversations with local primary and community services on integrated care. They are on the cusp, if they get the right support. We will work with them to get them up and running as early as next year.’

However, in some areas there were significant ‘unreconciled pressures between available funding on a fair shares basis and core business productivity’.

He continued: ‘Whether you call them distressed or economies that are out of balance, there is a recognition that their existing option set is not going to produce sustainable, high-quality services. We want to work with that group too.’

The majority of local areas would fall into the third category – in these, there were pressures, but a range of options available. The fourth covered new towns and areas with large population growth. ‘In these there are interesting choices available. You can almost design from a blank sheet of paper.’

He added: ‘In the material we will publish before Christmas [planning guidance] there will be mainstream allocations to support frontline services. There will be at least £450m available to begin the transformation from next April, both to build the general practice infrastructure and the broader transformation of health economies across the country.’