NHS Confederation - Changes can’t wait for next general election, says Nicholson
28 Mar 2014 11:56 AM
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:
- Patients taking more control of their own health and
healthcare.
- Extending primary care at scale.
- 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”.
- Fixing the urgent and emergency care crisis
.
- Elective care.
- 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:
- The
individual level, where when the NHS interacts with the person it recognises
both their mental and physical health needs.
- 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:
- 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.
- Improve the physical health of people with existing
mental health problems – 68 per cent of members say we need to reduce
demand through prevention.
- Exploit the opportunities presented by digital to
improve efficiency.
- 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.
- Develop a vision of what our future workforce needs to
look like.
- Urgently address the funding question – we must
make sure mental health services are not subject to a fourth year of real-terms
cuts.