How heroic efficiency savings will be made, being assertive, and underwear sales: the key points from Simon Stevens, Sir Bruce Keogh and Jane Cummings’ answers to Commons health committee questions on Tuesday.
The NHS England trio - chief executive, medical director and nursing director respectively - were quizzed by MPs in a marathon three-and-half-hour evidence session.
1. Efficiency sceptics
There was some scepticism from MPs, particularly from Labour MP Emily Thornberry, about whether the service can make £22bn of savings over the parliament, as national government and officials have indicated. NHS England chief Simon Stevens explained where he thought these savings would be made. A quarter would come from “prevention and demand moderation”, which he described was “a combination of the things that are going to come from prevention and alternatives to hospital admissions”. Another quarter would be achieved by reducing the prices charged to the NHS, while the third chunk, about 50 per cent, would be from the “voluminous” productivity opportunities in the provider sector, Mr Stevens explained. Easy, then.
2. Frontloading investment
The timing for publishing the government’s spending review – which will set the all-important phasing for NHS spending growth – is now confirmed for November. Mr Stevens was questioned about whether increases during the parliament would need to be “frontloaded”. Treading carefully, he said it would be a decision for the chancellor. But Mr Stevens added there “would clearly need to be investment” to ensure major service changes as outlined in the Five Year Forward View could be brought about.
3. Friday feeling: more evidence on weekend mortality
NHS England will shortly publish research it believes will confirm a ‘weekend effect’ in NHS services including higher mortality, NHS England medical director Sir Bruce Keogh told the committee. Sir Bruce told the committee “there was pretty clear evidence of a weekend effect” starting on Friday and carrying on into Monday, even after taking into consideration the more serious conditions of patients admitted at weekends.
4. Underwear salesmen
Mr Stevens appeared to direct a jibe at Sir Stuart Rose, whose long-awaited report into NHS management was published last week. He told the committee the complexity of managing the NHS was greater than that of selling underwear – and explicitly referenced Sir Stuart’s former position as the chief executive of Marks & Spencer. He immediately joked that his comment should be “struck from the record”.
5. Leanest system of them all
Mr Stevens commented on Department of Health figures published today showing the costs of running the NHS had fallen by about £7bn since 2010. “I suspect we are probably now the leanest when it comes to the management costs of any country,” he said. The DH’s short statement on the costs and benefits of the Health and Social Care Act 2012 reforms said costs were lower than planned and savings greater. “This means the government has successfully achieved its aim to reduce NHS bureaucracy costs by a third,” it said. It didn’t consider the opportunity costs or damage caused by upheaval and distraction, of course.
6. Further vanguards
The first wave of urgent and emergency care vanguard sites are to be announced this week, Mr Stevens said.
7. Assertive posture on public health
Asked by committee chair Sarah Wollaston about whether the government’s £200m cuts to non-NHS public health funding would affect frontline services, Mr Stevens said it was “too early to say… but going forward that would not be a smart approach across the rest of the portfolio”. He called for a “more assertive posture” towards the health impact of tobacco, alcohol and sugar, and said that – while financial benefit from prevention efforts would not be felt until the latter half of the parliament - “nevertheless it is clearly the right thing to do”.
8. Pay rises ‘in the fullness of time’
Mr Stevens, pressed on his view about the budget announcement of four further years of public sector pay restraint, said: “In the fullness of time, ultimately the NHS needs to pay [staff] the growing rate relative to the private sector, in order to recruit and retain the staff we need.” He stressed he was not making a political point.