Your essential update on health for the week
HSJ Catch Up
This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.
NHSE/I’s brave new world
Thursday was the day NHS England and NHS Improvement held their first joint public board meeting. To mark the occasion, the health service’s two biggest arm’s length bodies announced several changes to how management at the centre of the NHS is going to work.
- NHSE and NHSI will move to a single “financial and operational planning and performance” regime.
- This will involve the two organisations sharing a single appointee in several senior roles: chief finance officer; medical director; national director for transformation and corporate development; and nursing director.
- The latter change will be eased by Jane Cummings retiring as NHSE’s chief nursing officer after six years in the role.
- NHSI is creating several new national director roles: chief provider strategy officer; chief people officer; chief improvement officer; and chief commercial officer (it is not yet clear which current national director roles are being scrapped).
- NHSE/I is also going to set up a new “NHS assembly” (official name TBC) for national and local leaders, which will “codesign” the government’s upcoming long term plan for the NHS and oversee progress of the Five Year Forward View. Some readers may think it looks similar to the NHS Modernisation Board of the early 2000s.
Happy birthday for the NHS?
Before the NHS turns 70 on 5 July, the government is expected to reveal its broad ambitions for the “sustainable long term plan” and the accompanying “multiyear funding settlement” promised by Theresa May in March.
Much speculation abounds about the size of the increase, as do questions of whether there will be legislation to formally unpick some of the Lansley act.
How big an increase in the health budget that settlement will provide is understandably the question receiving the most attention, but there are also others worthy of examination.
When it comes to “how much”, the Treasury will know anything lower than 3 per cent real terms per year is likely to be rejected by the NHS, while those negotiating for health realise that anything above 4 per cent is likely to get short shrift from the chancellor.
Therefore, HSJ predicts the final settlement will start with a three.
This is rich fare compared to the gruel the service has had to live on since 2010, but it is also below the average historic funding growth received by the NHS.
Next, people will want to know how long the new funding commitment will be made for and what shape it will take.
Within the corridors of power, the prime minister’s promise is often referred to as “a 5-10 year plan”.
This is not just people keeping their options open – it is also a recognition that there are, in effect, two plans being developed – one to take us to the end of this Parliament and the other to the end of the next decade.
The distinctive part of this reform package will be the “10 year plan” for longer term investments, particularly in workforce. Here all the negotiators are trying to avoid the mistakes made too often by past policymakers and ensure they plan now for medium and long term increases in demand. This will no doubt be informed by the workforce strategy being developed by Health Education England.
- Read HSJ’s editorial on the long term plan in full
- Government could scrap ‘NHS England ringfence’ in long term plan
- Government not planning to repeal Lansley legislation
Solving the big data puzzle
This week, several more pieces of NHS data sharing puzzle fell into place.
Not since Care.data have national leaders dared to be so publicly ambitious, and enthused about using patient data and the potential of big data to cure the service’s woes.
The gamble is that by stressing “local” patient information sharing for direct care, and kicking the can on national collections and the terms of commercial access further down the road, the public and clinicians will buy in this time round.
The first puzzle piece this week was the first three “local health and care record exemplars” announced on Wednesday.
National leaders hope these will be just the first in an interwoven quilt of such records covering the country, containing between them a detailed record for every citizen.
The term “local” is a stretch for these records, which will cover dozens of health and care organisations and millions of citizens. The London record alone will cover 8 million people.
It is these records that will be the meat to NHS big data grinder.
On Friday, two more jigsaw pieces will be put in place: the snappily titled general data protection regulations (GDPR) and the national patient opt-out.
The EU-wide GDPR will make organisations, including within NHS, more accountable for the personal information they collect, while the opt-out will allow patients to be left out of sharing their NHS identifiable data beyond direct care (though probably not in all instances).
Speaking to HSJ this week, health minister Lord O’Shaughnessy described these steps, and several others aimed at data security, as public reassurance, tools that demonstrate to the public that the NHS can be trusted to handle their confidential records.
Care standards expected to fall
In an interview with HSJ, the departing Care Quality Commission chief executive Sir David Behan has warned the regulator is expecting a deterioration in care standards across health and social care during 2018-19.
In a stark message, Sir David said the regulator’s modelling has predicted deterioration in ratings between 10 per cent and up to 50 per cent depending on how bad things get.