The health service is entering a “transformational” next phase in which services spanning different sectors are likely to be contracted to serve specified segments of the population, according to NHS England’s chair.
Sir Malcolm Grant said the service had made important “transactional” changes in recent years but, under the leadership of newly appointed chief executive Simon Stevens, it would undergo a “change of direction”.
These shifts should include a dramatic change to the “notion” of patients, who will “become providers [and] co-producers of healthcare”, he said in an interview with HSJ.
Another message resulting from his organisation’s review of NHS strategy was the need to put more focus and resources into prevention, including addressing poor outcomes linked to inequality, Sir Malcolm said. The need to address neglect of mental health had also been raised.
The Call to Action strategy review began in July and is due to publish primary and specialised services frameworks by March.
Local commissioners have been told to write five-year strategies for late June, so Mr Stevens’ April arrival will be close to the end of the process.
However, Sir Malcolm insisted the current UnitedHealth president of global health would “have an impact the whole way through”, and said he was “in regular discussion” with him.
“He identifies the Call to Action as the platform on which we can start to make the transformative changes we all understand are needed,” Sir Malcolm said.
“We should see his incoming leadership as part of the transformation. I see him as the person who will take us through to the next phase of the NHS.
“[Current chief executive Sir] David [Nicholson] has laid the foundations − had somebody not got a grip on [making savings] we would be in desperate straits now. The next stage is ensuring we can go beyond the transactional changes into the truly transformational.”
Sir Malcolm said NHS England was not “coming up with a blueprint” for the service but “signalling our change of direction”.
However, several times in the interview he highlighted the model of contracting single services to provide all primary, secondary and social care for a defined, “segmented patient population” in an area, such as the frail elderly.
He referred to the tender, similar to this arrangement, for an £800m integrated older people’s service currently being run by Cambridgeshire and Peterborough Clinical Commissioning Group.
Sir Malcolm predicted: “We’ll see more segmentation of patient populations, concentrating on particular areas of need.”
These “unitary model” services would be “compensated on a capitation basis”, he said, adding structures should be flexed to enable such models.
“We’re starting to see a variety of different models, including a strong interest on the part of the acute sector to reach out into primary care,” said Sir Malcolm.
Asked whether NHS England would support CCGs pressing rapid service change in disagreement with providers such as events revealed by HSJ last week in Oxfordshire, Sir Malcolm said it would “pursue what’s best for patients”.
This included supporting CCGs “having a well crafted plan”, but also being “conscious of the need to… stabilise the provider side because that’s also in the interest of patients”.
End of life care
Sir Malcolm Grant said “the question of death” had become an “inherent part” of the consideration of future NHS strategy.
The NHS England chair said death and end of life care involved “discussions which are quite difficult to have” but indicated they should be considered as “part of a big public debate about the way in which we provide healthcare, the right of patients not to be treated if they choose that, and to have a dignified death”.
He said the majority of patients did not want to die in hospital and added: “People do not want to die alone, and yet a large proportion do die in hospital.”
“It’s an inherent part of what we’re talking about in the Call to Action,” he said, and that the issue had also been raised by Baroness Julia Neuberger’s review of the Liverpool Care Pathway, which reported in July.
Sir Malcolm said: “I stress this is not any part of a discussion about funding − it’s about quality care and refocusing around individuals, their needs and preferences.”