WIREDGOV

The health service must undergo a significant set of changes to ensure its future sustainability, but they must be done now and cannot wait for the next general election, outgoing NHS England chief executive, Sir David Nicholson, has said.

‘Urgent’

In one of his last public speeches before stepping down as head of NHS England, Sir David’s speech at the Mental Health Network’s annual conference outlined six characteristics of sustainability – which apply across mental health and physical health services.

He said the changes needed to ensure the services' future sustainability are urgent and cannot wait, but that he feared there would be a ‘conspiracy’ between political parties not to talk about the health service at the next election.

The NHS Confederation is leading a major pre-election campaign – the2015 Challenge –  which calls on politicians to create the space for change, and the NHS to be ready to make the change, and do it well.

Sir David listed the six characteristics as:

1. Patients taking more control of their own health and healthcare.
2. Extending primary care at scale.
3. Creating an integrated model to support people with multiple and complex needs, hence the Better Care Fund – “first time in this country there is a budget ring-fenced for out-of-hours care”.
4. Fixing the urgent and emergency care crisis .
5. Elective care.
6. Specialised services.

He spoke of other issues NHS England will need to deal with to help the health service to continue to provide great care, including data and measuring what the service does, and improving the quality of commissioning across the NHS.

He also identified that the organisation will need to sort out issues to do with the tariff and the interface between what is commissioned by clinical commissioning groups and specialised services.

Parity

On the issue of parity of esteem, he warned of the dangers of “sloganizing” and a need to be clear what parity means in a practical sense.

He clarified that for NHS England, it relates to:

1. The individual level, where when the NHS interacts with the person it recognises both their mental and physical health needs.
2. The service level – ensuring service performance standards apply across the board.

Foundation trust status

In a Q&A session, Sir David was asked whether the foundation trust model “is still worth it?”.  He responded saying the “old policy is dead” and we need to think more creatively about how services are organised in future. “What other health system would organise around one model of healthcare provision?” he asked.

Transformational change

Sir David started his career in mental health and spent a third of it directly managing and running mental health services. He told the audience that he was drawn to the sector because of the big transformational changes taking place at the time – the closure of the big asylums.

Coherent strategy

His speech came after a presentation from the Mental Health Network’s (MHN) senior team which called on incoming NHS England chief executive, Simon Stevens, to develop a coherent strategy for mental health.

MHN chief executive, Stephen Dalton, and director of policy, Becky Cotton, outlined six areas of focus:

1. Focus on those areas where the NHS can improve outcomes and save money – improving the mental health support offered to people with long-term conditions.
2. Improve the physical health of people with existing mental health problems – 68 per cent of members say we need to reduce demand through prevention.
3. Exploit the opportunities presented by digital to improve efficiency.
4. Ensure mental health service users can enjoy the same rights as other NHS patients – to access services within guaranteed waiting times and to choose their provider.
5. Develop a vision of what our future workforce needs to look like.
6. Urgently address the funding question – we must make sure mental health services are not subject to a fourth year of real-terms cuts.