Simon Stevens calls for finish to "cookie cutter" method to NHS reforms

Simon Stevens informed MPs that by worldwide standards, England currently has a centralised hospital method. Photograph: Owen Humphreys/PA

In his 1st physical appearance at the well being pick committee, NHS England chief executive Simon Stevens exposed important departures from orthodox thinking about the potential of the overall health support, even though repeatedly championing neighborhood autonomy in choosing the very best way to provide care.

Throughout far more than two hrs of questioning, Stevens exposed deep scepticism about the effectiveness of integration schemes being planned as component of the Much better Care Fund. He highlighted research published final month by York University, which discovered that not one of 38 integration schemes in eight nations – including 13 tasks in England – secured a sustained, prolonged-term reduction in hospital admissions.

As Stevens informed MPs: “There are all types of techniques of undertaking these factors which do not function.”

He believes integration schemes are trying to plug gaps in standard providers rather than make very good solutions function collectively far more successfully. Much better Care Fund ideas can expect extreme scrutiny from NHS England to test whether their assumptions are credible and no matter whether regional hospitals have been closely concerned in drawing them up. With Basis Trust Network analysis revealing that just two% of hospitals truly feel entirely involved, a lot of ideas are likely to be found wanting.

But his most revealing feedback have been on his expectations for the potential of regional hospitals. He supported clinically led reforms such as centralising stroke services and NHS England’s urgent and emergency care technique constructed all around professional centres for existence-threatening and severe circumstances. Nonetheless, in a striking departure from the centralising creed of his predecessor, Sir David Nicholson, Stevens stressed that by global requirements England previously has a centralised hospital method, and dismissed the idea that several nearby hospitals would need to have to disappear.

He said: “It may well be that if we get truly inventive about what it would get to sustain neighborhood hospitals, it might not all often be a query of merging or closing in the way that some appear to consider.”

Taken with each other with his remarks to the committee about searching at new ways of delivering major care solutions, and the encouragement he gave in his first speech as chief executive to suppliers and commissioners searching at new care designs, the invitation is there to hospitals struggling to find a part and a safe fiscal future to propose radical choices to their recent operations.

In some approaches this touches on similar ground to suggestions from the shadow health secretary, Andy Burnham, about district hospitals getting to be care hubs that include social solutions.

Stevens’s hints about the long term of regional hospitals chimed with his repeated endorsement of nearby innovation and autonomy, whilst dismissing what he described as the centralist “cookie cutter” method to reform.

There was much for clinical commissioning groups to celebrate in Stevens’ feedback. As nicely as his help for neighborhood diversity he backed a significantly bigger function for CCGs in establishing main care, in contrast to the existing setup of NHS England’s 27 area teams leading on main care commissioning, he highlighted the value of neighborhood funding answers this kind of as capitation payments.

In even more proof of the critical eye he is bringing to NHS England’s centralising tendencies, he broadly accepted that as well many companies are now being commissioned by his organisation beneath the banner of expert services – expanded from an original £8bn to £12bn and overspent by all around £400m in 2013-14. CCGs can anticipate some of these to be returned to neighborhood management.

So what about the NHS spending budget? By highlighting the a lot reduce growth in GP numbers in contrast with hospital medical professionals it is clear exactly where he sees the strongest situation for investment. In terms of the complete pot, he has promised to reveal inside a 180 days where demand for solutions and present funding will take the NHS more than the subsequent parliament, how significantly the NHS is on program to do to bridge the gap, and what needs to come about next.

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Simon Stevens calls for finish to "cookie cutter" method to NHS reforms