• NHSE boss argues statutory changes would “accelerate” long term plan
  • Stevens says legislation could streamline NHS management nationally and locally
  • He also sets out how NHS will approach major finance reforms

Simon Stevens has called for “pragmatic” legislative changes to help the NHS deliver its new long term plan over the next decade in a speech to health service managers today.

The NHS England boss also pledged that major reforms to the NHS funding arrangements kicked off with the publication of tariff proposals for 2019-20 today, would deliver a “fairer, more transparent” system.

Addressing the NHS Providers conference in Manchester, Mr Stevens argued: “[The NHS] would be accelerated on the journey if we are able to get pragmatic changes to the way in which aspects of our legislative arrangements work.”

This is despite a number of political commentators and senior figures in the service believing it is unlikely significant NHS legislation could be passed because of the weak government and Brexit processes.

However, in the summer, when announcing the long NHS plan, prime minister Theresa May said: ”We will consider any proposals from the NHS on where legislation or current regulation might be creating barriers.” The Commons health committee has also asked the NHS to put forward proposals.

Mr Stevens gave more detail than previously on the areas where statutory changes should be targeted:

  • To support “the ability for local NHS organisations to function in a way that is more consistent with the move towards systems working [and population health]”;
  • Removing “impediments [to local organisations working as systems] which exist [in] procurement and competition legislation”;
  • And “streamlining some of the national accountability arrangements”, building on NHS England and NHS Improvement’s joint working.

He said NHS England and Improvement were already embarking on cutting their combined costs by 20 per cent, although he said this would take “several years”.

Consensus around what the “appropriate legislative changes” were would be built by an engagement process across the NHS about the long term plan between December and Easter, he said. 

After this, he conceded it would be up to parliament whether it passed legislation, and stressed the importance of pressing on with changes within the existing laws in the meantime.

The NHSE chief executive also explained that the NHS would “pivot” from the current financial regime based on control totals and sustainability funds, to a new system.

He said the tariff engagement document for 2019-20 published today set out proposals for “a one year tariff for next year” with changes to the “whole way in which health services are reimbursed”. This would impact urgent and emergency care, outpatients, telemedicine appointments, maternity, and mental health and community health services, he said.

He said: “A significant element of the provider sustainability fund is set to be put into prices through the tariff [and] that will be part of a five year transition to a fairer, more transparent, simpler reimbursement mechanism across the sector.” He confirmed PSF would not all be removed in 2019-20, and said: “Going cold turkey in a 12 month period is not actually possible.”

He added: “We are looking at whether at the end of that five year period we will still need an objective, rules based structural fund to pick up the differential costs of care not otherwise covered through tariff.”

The “first update of the market forces factor that we have had in over a decade” would address geographical fairness of allocations, he added.

It is unclear what sum will be taken out of the PSF next financial year and moved into tariff or other payment mechanisms.

Mr Stevens also used his speech to say that the long term NHS plan was likely to be published in late November or early December.

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