The spending review’s frontloaded settlement for the NHS is highly welcome and was expertly negotiated, writes David Hare

The NHS’s spending review settlement announced by George Osborne should reassure NHS leaders about the national backing for partnerships with independent service providers.

It is time these opportunities received far greater attention locally to continue unlocking better services – such as direct GP access to specialist care and diagnostics – and potentially to attract new funding.

David Hare

David Hare

Source: NHS Confederation

“This welcome injection of common sense buys time”

The spending review’s frontloaded settlement for the NHS is highly welcome and was expertly negotiated but offers only a small window of opportunity to fundamentally reimagine the way in which health and care services are delivered and to put the service on a sustainable long-term footing.

Unprecedented challenge

Some of the extra investment secured by Simon Stevens and Jeremy Hunt will be used to bring much needed stability to the NHS at a time of unprecedented challenge.

Jim Mackey, chief executive designate of NHS Improvement, has wisely adjudged that the NHS tariff settlement for 2016-17 needs to be devoid of unnecessary complexity and uncertainty while also stripping out unhelpful volatility from the pricing system.

This welcome injection of common sense buys something else that is so important: time.

Time to think, plan and assess the kind of health and care system that patients want in their communities and how all organisations in localities can meet those needs and do so in a sustainable way.

Several things will help here, including the area plans that are due by next summer.

Long-term partnerships

What will also be important to consider and take forward will be the spending review commitment to encouraging long-term partnerships between the NHS and the private sector to modernise buildings, equipment and services, and deliver efficiencies.

The lessons we have learned from public/private interactions is that if incentives are aligned and relationships are built on trust and shared objectives then huge progress can be made.

Mature conversations focused on patient need can drive meaningful change

There are many existing examples including diagnostic imaging, pathology, clinical home healthcare, primary care networks, NHS 111, community services and acute sector collaboration that demonstrate this very clearly and illustrate that mature conversations focused on patient need can drive meaningful change.

The chancellor’s recognition of this in the spending review was welcome and should offer reassurance to NHS leaders that they will be given the necessary backing in instigating and developing these partnerships where they work for patients.

Service provision

So what might some of these partnerships look like in future? In a capital constrained environment where capital funding will be flat until the end of the decade, there is undoubtedly a need to identify alternative sources of funding and to leverage that into service provision.

A recent HSJ editorial made this point. Through the spending review’s signals over partnerships with the private sector in areas such as diagnostics, acute care collaborations, new models of care and accountable care organisations there is real scope to inject transformation funding from non-exchequer sources.

There is real scope to inject transformation funding from non-exchequer sources

Specifically, there is real scope for developing direct access for GPs to MRI, pathology and other diagnostic modalities, rapid access to specialist secondary care cancer services, radiotherapy, chemotherapy and rehabilitation.

Much of this is already delivered by independent sector providers but to meet the ambitions of the independent cancer taskforce significantly more capacity will be needed to deliver a world-class cancer service in England.

With independent sector providers directly engaged with investors there is the potential to attract external funding into other workable projects, which could reshape care and overcome some of the funding constraints that we expect to see in the years ahead.

Heroic leadership

There is also scope to challenge independent sector providers to take more risk and to use investment to double-run services as the point of care shifts to new and different settings.

This will require well-judged commissioning decisions but also provider interaction and coordination, assessing the different skill-sets and capabilities that different organisations bring and deploying those for the benefit of patients.

We believe that the opportunities for doing things differently are significant – no longer can single organisations hope to solve the challenges of their population alone and heroic leadership takes you only part of the way.

Talking to NHS leaders it is clear that they are very pragmatic about working with the private sector and acknowledge the role that private sector partners already play in transforming health and care services.

With the backing offered to these models by the spending review and the benefits of several years of learning about what works in drawing on private sector support for NHS-funded care, the opportunity is there for NHS leaders to have a new and different conversation with the private sector.

David Hare is chief executive officer at NHS Partners Network