Expect years of fundamental changes and austerity, says Grant

He told HSJ: “There is going to be nothing by way of relief from austerity in the NHS for years to come, so we have to find new ways of doing things.”

The commissioning board has not yet set out in detail how it intends to improve services or how closely it will be involved in planning local changes. 

However, it is expected to produce a strategy later in the year, having engaged with clinical commissioning groups and others. It will also need to respond to the health secretary’s mandate. A team is being put together, led by its director of improvement and transformation Jim Easton, with the aim of “driving transformation and change” in the service.

Professor Grant said: “We’ve got to work with the other arm’s length bodies and with the secretary of state to think through the strategic framework for the next 10 years – and not less than 10 years.”

He said it would not be a “top-down plan” but an attempt to “develop a vision in partnership with all the major players [for] really driving a much leaner and more efficient NHS where we can demonstrate that outcomes are continuously improving”.

Professor Grant said improving outcomes while NHS funding stayed the same or fell would “require fundamental review of models throughout the NHS as to how healthcare is provided”.

“It will require quite considerable thinking about the role of general practice and about the role of hospitals”, he said, citing the concentration of specialist acute stroke services in London as an “exemplar”.

Professor Grant said: “There are [potential] wins across the whole system but the underlying implications of those [changes] are significant.”

He predicted service reconfiguration would “be accelerated by the very significant spending responsibilities and power that CCGs have”.

He said an “awful lot of improvement” could be achieved in “packages of care for frail elderly patients” by providing more integrated community care. Another main challenge was “what happens to those hospitals that lose specialist services because [they are] concentrated on safety grounds elsewhere?

“Over the next 10 years there will be fundamental changes in provision of health services,” he said.