Responding to COVID-19: insight, support and guidance
On 12-14 July Manchester hosted another successful CIPFA conference, with two days of talks, discussions and workshops on the theme of ‘People, Place and Prosperity’.
Jim Mackey covered key messages from the NHS provider sector as well as focussing on his permanent role in the Northumbria system to which he is due to return in the Autumn. After opening by thanking NHS staff for their support during recent difficult events and stating that we should "value and cherish the best service in the world", he went on to look at overall achievements with a slide entitled 'The NHS has delivered the impossible – provider finances turnaround in 2016/17'.
This showed how the provider sector had finished the year with a £791m deficit (an improvement over the £2.5bn deficit posted in 2015/16) once the sustainability and transformation fund had been applied. The sector had also delivered an "eye-watering" CIP of 3.7% whereas "no other system had achieved more than 2% for a sustained period". Contributing to this success was, he said, reduced spend on agency and locums which was down by £700m from 15/16. However, there is still much to do.
One of the key messages was the need to return to a more locally focused system, which had been somewhat lost in the recent times of more centralised control. The future needs to be about devolved leadership, earned autonomy and the blurring of lines between both commissioning and providing and between health and social care. This should enable greater challenge to spend on corporate and contracting overheads in the NHS.
Jim went on to talk about the Accountable Care System in Northumbria which had come into being on 1 April 2017. Success factors include: taking time to plan; developing together through action; not dodging the hard stuff but finding areas of common ground. Accepting that this kind of development "isn’t quick" is required as well as balancing the needs of the institutions alongside the system and in particular finding time to both talk and listen. Having pots of money in silos creates tension, whereas pooling resources provides greater opportunities.
In the Q&A session, questions regarding NHS capital resources and rules were raised, suggesting that the NHS might benefit from a regime more similar to that of local government. "The NHS is boxed in" by current rules he said, and a "more enlightened and liberal approach" would enable the NHS to take greater advantage of the current low interest rates.
Niall Dixon of the NHS Confederation (a membership body which represents NHS leadership) spoke next. He looked more broadly at the context of pressures within health and social care, reflecting that public services have so far responded well to the step change in demand which has already taken place due to changes in demographics, but strains are evident. Reductions in local government funding have meant that over 100,000 people, are now not receiving social care which they otherwise would have received. We urgently need a national, cross-party discussion on the vision for health and social care provision in the future which includes a decision on the level of care we are willing to pay for. Otherwise the future of health and social care is unsustainable in the long term (see CIPFA’s More Medicine Needed for our view on this issue).
Sustainability and transformation plans (STPs) are tasked with being the vehicle to deliver future changes but their implementation has been challenging – too often the ‘S’ of sustainability has overwhelmed the ‘T’ of transformation. It is vital that regulatory and accountability regimes don’t get in the way of the work of the STP, otherwise efforts to bring in new models of care can be associated too closely with cuts.
His final thoughts were on the workforce, an area which he believed is still being largely neglected in NHS planning. The confederation is urging government to ensure that the hoped-for increases in public sector pay are backed by adequate additional funding. Workforce issues become particularly acute as we start to see the consequences of the Brexit vote, and as a member of CIPFA’s Brexit Advisory Commission he looked forward to helping influence government thinking to ensure definite plans are developed and implemented.
Social media comments suggest that these sessions were well received by delegates ("practical, pragmatic and insightful"), although some comments suggest that the wider public health agenda could have had greater focus.
This practical workshop provided delegates with the opportunity to learn from two areas in which integration is very much in action on the ground.
The first case study, from Public Finance Integration Award Winners Plymouth and New Devon explained how integrating finance systems, reporting and structures had brought about substantial synergies in the area. Plymouth County Council’s Section 151 officer, Andrew Hardingham, was able to explain to delegates the processes in place which enable the service integration to be supported by a combined financial regime. Their aim of ‘one system, one budget’ has led the area to maximise pooling wherever this is legally possible, supported by a system of ‘aligning’ budgets which cannot formally be pooled. Further details can be found in our integration webinar.
This was followed by a session from Julian Baker, Director of National Collaborative Commissioning, NHS Wales on innovations across Wales to create a single commissioning framework, contract and associated portal for the booking of nursing and residential care. This agreement, which covers all seven health boards alongside the 22 local authorities aims to ensure consistent pricing and quality is achieved from the 1700+ beds in 202 care homes. In explaining the advantages of the project, Julian cited achievement of a higher percentage of care closer to home, improved quality and increased compliance with best practice. But it was clear that the significant financial savings struck a chord with attendees. Want to find out more? This initiative will feature in our case study examples at our Health and Social Care Conference on 21 September.
Finally, the workshop looked at the initial findings from our survey on integration (conducted in association with ImPower consulting). The full findings will be shared at the health and social care conference on the 21 September, so there’s still time to add your views.