The new NHS England chief executive has said he wants to “accelerate the redesign of care delivery” and create “far greater local flexibility” in services, structure and system rules.
In his speech at the NHS Confederation conference last week Simon Stevens also indicated he was working on changes to payment rules, including making “a steadily increasing proportion of payments [to providers] tied to performance, quality and outcomes”.
He told the conference in Liverpool he wanted to “accelerate the redesign of care delivery”. He added: “Rather than constantly debating the reorganisation of our management tiers, let’s now ask the more profound questions about how care is actually being delivered”.
Mr Stevens said the NHS needed to “tear up” silos between primary, acute and community services.
In relation to financial incentives available to parts of the health service, he said: “I can tell you now, we’re going to be taking a very hardnosed review of what we’re actually getting for that money and whether we can do better.”
Mr Stevens said that while he wanted “far greater local flexibility to better match the health and social care needs of the people we serve”, his approach would not be only to “let a thousand flowers bloom”, which would be “chaotic” and could end with “poorly designed” services.
He said: “Yes, we need local adaptation but we need to do so in the context of national thoughts about the kinds of changes that are required. That is easier said than done.”
He also called for a much more rigorous and “quantitative” approach, especially in terms of managing pilots.
Mr Stevens said: “We do not apply the same disciplines to the way we go about innovating in our service delivery that we would expect clinical professionals to apply.
“We need to get much more quantitative about how we do things in the NHS. If we did that I think we would get much more support from our clinical partners.”
Mr Stevens reiterated his message that, while in some cases services needed to be concentrated, he believed in others they could be redesigned to make facilities such as district general hospitals more viable.
He said: “Rather than uncritically adopting the merge and centralise as our overriding ‘meme’, let’s go with ‘horses for courses’. In some places mergers and traditional reconfigurations will – after careful stress testing – clearly be needed, and they will have NHS England’s full support.
“But let’s also allow complementary models to emerge, be tested, and adapt over time, in different communities, reflecting their different legacy care patterns and the heterogeneity of their patients.”
Mr Stevens also said:
- He wants to see “a steadily increasing proportion of [providers’] payments tied to performance, quality and outcomes”. NHS England will be “undertaking a hardnosed review” of incentive schemes including commissioning for quality and innovation, the quality premium, and GPs’ quality and outcomes framework.
- NHS England, with Monitor, will also explore changes to payment systems. These include “different approaches to sharing utilisation risk… from volume based payments at one end through to delegated capitated budgets at the other” and “new reimbursement models for some elective conditions, an expansion of ‘year of care models’ for people with long-term conditions, and alternative funding arrangements for emergency and urgent care”.
- He wants “to see – and I’m confident this is a shared view with Monitor and [NHS Trust Development Authority] – an NHS that is more flexible, more adaptable”.
- In the autumn he will publish a “five-year ‘forward view’”, which will include “the sort of new care models that could succeed” and “more locally permissive policy and regulatory environment that would support them”. It will also include “alternative scenarios for demand and for efficiencies – and what both imply”, and “the comparative advantages that a National Health Service offers – and how we can further capitalise on them. And how investment in the NHS supports a prosperous and growing Britain.”
- Different commissioning approaches NHS England will explore include “working with the third sector on new ways to commission services”; “flexibly supporting new models where the commissioner-provider split is differently placed along the demand/supply continuum”; “beginning to measure and manage not just the ‘flow’ of healthcare consumption, but the ‘stock’ of population health risk”; and “giving consideration to population-based virtual commissioning budgets that blend primary care, local hospital and community, and specialised services”.
- The NHS should “embrace and harness… three quite fundamental shifts in the practice of modern medicine”. These are: personalised medicine, the use of data and the role of patients and communities.