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What will the new Parliament bring for NHS providers?

Miriam Deakin, head of policy at NHS Providers, discusses the opportunities and challenges facing providers during the new Parliament. 

With Parliament returned and the new ministerial team in office, it is timely to reflect on the priorities for health and care facing the new government. This article offers a perspective from NHS Providers. 

The reappointment of Jeremy Hunt offers an opportunity for continuity within the health portfolio. The secretary of state has been known for his commitment to transparency, the Better Care Fund and investing in performance. The Conservatives endorsed the Five Year Forward View (5YFW) and Hunt’s first statement since reappointment reflected an interest in out-of-hospital care and services for older people. Significantly, the prime minister opted to focus on the NHS, and a commitment to seven-day services, in his first speech on returning to Downing Street. 

However, while there is consensus behind the need for more preventative, integrated models of care, the NHS faces a series of pressing challenges. Firstly, with the spending review upon us, there are tough decisions to be made about the balance of funding and how the health and care system can sustainably meet changing needs and an annual growth in demand of 4%. 

Deficits 

Provider deficits have risen rapidly in the last two years, from a sector surplus of £593m in 2012-13 to a projected deficit of over £2bn this financial year. Despite best efforts, a number of national access targets, including the four-hour waiting target for A&E and referral to treatment times, are in breach. Politicians will wish to stabilise NHS performance in the short term, as well as to ensure appropriate investment for providers and their partners to transform care in the medium term. 

Secondly, the welcome commitment the Conservatives made to invest the additional £8bn funding signalled within the 5YFV, comes with a requirement the sector finds an ambitious £22bn efficiencies by 2020. Although providers have delivered considerable efficiencies to date, the NHS books have been largely balanced by holding flat the pay bill, which is no longer sustainable. We are therefore keen to ensure the sector plays a fuller role in working with government and the national bodies to co-develop a realistic and transparent efficiency plan for the next five years. Learning from the Better Care Fund, this could also assist any further roll-out of shared health and social care budgets locally. 

Thirdly, we know that staff engagement is our best predictor of quality of care. Yet the workforce faces a number of challenges including: developing pay terms and conditions, investing in leadership, recruiting and training staff in sufficient numbers, meeting shortages in key disciplines and rolling out seven-day services. The introduction of staffing ratios alone has added an unfunded £1.5bn to providers’ staff costs, a key driver of the deterioration in provider finances. Government will want to be assured the NHS workforce is affordable. Providers also need sufficient flexibilities to recruit, retain and reward their staff appropriately. 

Finally, given the challenges the service faces, ensuring the right lines of accountability has never been more important. While an increase in central performance management may be tempting for ministers, provider boards need to know what they are responsible for delivering and expect to be held to account for that delivery. With this in mind, we remain full proponents of the provider autonomy and local accountabilities which sit at the heart of the foundation trust model, although we expect all providers to work increasingly with others to develop more integrated care models over the next five years. As collaborative working at local health economy levels becomes more central, it will be important for risk-based regulation to respect organisational accountabilities and recognise the local context in which providers are working. 

A policy framework that enables change 

NHS providers look forward to working collaboratively with partners in their local health economy to stabilise their finances and performance, and invest in transforming care. However, they can only do this within a policy framework that enables change. 

In the next year, NHS Providers will be working with government, national bodies and our members to ensure: 

• A stable NHS provider sector which can deliver improved and sustainable services;
• Appropriate funding for the NHS and social care, and a realistic plan for efficiencies;
• A sustainable, responsive NHS workforce strategy;
• An effective balance of provider accountability and autonomy with effective regulation; and
• A continued commitment from our members and the national bodies to drive and support the transformation of services. 

NHS Providers is the membership organisation for the NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS. Our members comprise 93% of all NHS foundation trusts and aspirant trusts – which collectively account for £65bn of annual expenditure and employ more than 928,000 staff.

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