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Stevens is not concerned with barriers to reform

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Simon Stevens set the scene at the recent King’s Fund Summit on integration.

His delivery was vim and brio and “towill the ends is to will the means” was his catchphrase.  

This year’s pressures are not caused by demand, oh no. The activity in 2015-16 is what the commissioners planned for. The cause of the deficits is providers’ spend on agency staff; the money that the NHS could have used to support them is in the better care fund. Stevens cut through the Gordian knot of complexity: badly managed nurse training and the better care fund are the reasons for the provider deficits.

If he didn’t have our attention before, he had it now. “We must retain constancy of purpose,” said Stevens, looking to the horizon. 

Integration is three missions, as anyone constructing policy from the rules of rhetoric will tell you: integrating care between primary and secondary; mental and physical; and health and social. This is more to do with integration within the NHS, note, than between councils and CCGs. 

The awkward fourth mission, left unsaid by Stevens, is a consequence of the first three: the integration between commissioners and providers.

He finished off by telling us about “distractions”. Too many agencies working nationally had too high a frictional cost and “loss of voltage”. So, things were going to be “different”. 

We will all have new “sustainability plans”. I hope that there will be a website with toolkits on it and roadshows with people from the big firms that remember my name from the community budget roadshows. If we don’t have good sustainability plans, we won’t be allowed our share of the £8bn that David Cameron said would there to save the NHS.

The biggest distraction for Stevens was the foundation trust pipeline, with trusts concentrating on being a new sort of trust, but one that still has recruitment and financial difficulties.

I’m fairly sure he described all work on foundation trust status as “faffing about”. I’m definitely sure he described the entire foundation trust regime as having produced “diddly squat” since inception. It might be better, Stevens said, to concentrate on making the local health economies work more effectively, not the constitutional status of its moving parts. This is code for the two other large agencies in the landscape, the Trust Development Agency and Monitor.

The government fought the election on tackling the deficit and protecting the NHS. Jeremy Hunt has returned to post and has blessed the Five Year Forward View as set out by Stevens. He is even clearer about what he has in mind and less concerned about naming the things that are getting in his way. “To will the ends is to will the means”.

Rich Hornby, chief financial officer, Coastal West Sussex Clinical Commissioning Group




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