NHS can succeed where it previously failed in shifting care to community, says NHSE CEO

Speaking at the ConfedExpo today Amanda Pritchard declared her ambition to make the NHS “the fastest improving health system in the world”. She said that by incentivising community services, the NHS could improve patient care, shift demand away from the acute sector, and deliver better value for money. 

Ms Pritchard acknowledged many in the audience would be thinking: “We’ve heard this before. We tried it, it didn’t stick”, before adding: “You know what? You’re right.”

However, Ms Pritchard said a series of “opportunities… we’ve never had before” would make the reforms possible and it was time for the NHS to “get serious about how we achieve” the desired changes. 

She claimed the service’s radical shift to system working had created opportunities. 

Ms Pritchard said she had noticed a “startling” change in some systems “from adversarial relationships to unity of purpose and trust. From shunting risk and cost — and people — from one service to another, to an understanding that both patients and taxpayers are best served when everyone is doing their bit.”

She added she was “under no illusions” that some systems “still aren’t there”, and said “through the NHS oversight framework we need to, and will, make it much clearer who is responsible and accountable for what” to provide a “basis for mature relationships”.

The other key “opportunities”, said Ms Pritchard, were presented by the long-term workforce plan and the greater use of technology, especially the NHS App.

Incentivising community care

The NHSE chief executive said the service needed to both “grow” and “do things differently”, starting with the “bedrock of the NHS”, primary care.  

The “GP workforce” will need to grow and “in some parts of the country faster than others”, she acknowledged. However, the 2022 Fuller Stocktake has provided a much-needed “modern vision for primary care”.

Pilots across seven integrated care boards designed to deliver the stocktake’s goals of “streamlined access to urgent care or advice, and proactive, personalised care for patients with long-term needs” would soon produce results that would be “integral to the future of the NHS”, she said.

Ms Pritchard said she wanted urgent community response teams, community frailty services, and single points of access to “become the norm” in all systems.

Key to achieving this goal was putting “our money where our mouth is… and where our patients are”.

She continued: “We know incentives work. We see it in the elective recovery fund, [where it is] driving extra activity. But we’ve also seen it improve outcomes through best practice tariffs.”

By way of example, Ms Pritchard said the 1 per cent of the population who were in the last year of their life account for a third of all hospital bed days, and that by cutting this number by 10 per cent through using incentives to boost community care, the NHS would benefit from the equivalent of “three large new hospitals”. 

This result could be achieved for other patient cohorts too she said, including through “equivalent models in mental health”.

The NHSE CEO declared: “The time is therefore right to do the work on how we can change our contracts and incentives to support this model, and we have started to do just that.”

The world’s ‘fastest improving health system’

Ms Pritchard said: “Our ambition is to be the fastest improving health system in the world, so improvement has to be everyone’s business.”

To achieve this she said: “We’re doubling down on our work through NHS IMPACT to support delivery of clinical and operational excellence, with a clear focus on our biggest challenges, [and] supporting both better care and productivity.”

In a reference to the improvement body set up by the last Labour government, Ms Pritchard said NHSE was “learning from the successes of the Modernisation Agency” and it would be soon “setting up improvement collaboratives and networks”.

The NHSE CEO also stressed the importance of boards “having the right information, whether that’s up-to-the-minute operational data from within the organisation or evidence and best practice from outside”.

In another reference to an NHS initiative undertaken with the last Labour government, Ms Pritchard said NHSE was “learning from the successes of the past [projects] like [the] Intelligent Board guides, and from those organisations which are already doing this. We’ve been working with many of you to pull together the best practice, evidence and ideas to shape how all organisations including NHS England use the information we have to better deliver for patients, communities, and staff, and we’ll be sharing that soon.”