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Mackey: Business case for STP short-term investments don’t yet add up

Despite STPs requesting more short-term investment to transform services in their area, the chief executive of NHS Improvement (NHSI) said he is yet to see a business case that would see the regulator get its money back.

Speaking at the House of Lords NHS Sustainability Committee hearing, where senior figures in health regulation called for the current system to be made more locally based, Jim Mackey argued that in the last period of health service reforms there had been “far too much” focus on regulation and “far too little” on greater local control of healthcare.

“The key thing would be to allow local flexibility within a clear set of national guidelines and rules,” Mackey said. “I think the innovations are there in appetite but it’s often easy for someone to inadvertently get in the way of that. The systems are very complex. I think in the next stage, we need to enable local innovation.”

However, he warned that the health system was “too constrained from a supply point of view”.

Mackey said that a number of providers and STP areas had requested more short-term investment to help them achieve a longer return, but that there was “no flexibility anywhere” and he had yet to see a business case that promised NHSI would get its money back for these transformations.

NHS England and NHSI have introduced strict individual control totals that trusts must meet to receive service transformation funding. However, a third predict that they will miss their targets this year.

In the hearing, Mackey added that, along with Simon Stevens, the CEO of NHS England, he was trying to develop a way to devolve responsibility for resources to leaders of STP footprints and devolved areas.

“As a fundamental principle we should look at regulation as a kind of safety net, not a guarantee of success,” explained Mackey. “The service runs on people taking decisions locally, taking control of decisions.

“In the last period there was far too much focus on the regulatory system and far too little focus on places like Manchester, on how people take control of their decisions. I think the regulator system needs to support that.”

Professor Terence Stephenson, chair of the General Medical Council (GMC), used his appearance before the inquiry to call for reforms to primary legislation to end “prescriptive over-regulation” and allow doctors to make decisions in areas such as patient safety, training, standards and tariff charges.

When asked if it would be better to have a single regulator for the whole health system, Prof Stephenson replied: “Nine regulators is possibly too many, one too few.”

He argued that reforms to regulation would not be appropriate when the NHS was at “a point of stress and crisis”, but that new regulation might be needed if roles in the health sector workforce changed in order to address staff shortages.

Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, who also appeared before the inquiry, said that the CQC was delivering more joined-up regulation by working more closely with NHS England, NHSI and CCGs.

He added that trusts were already taking up the CQC’s model of “a shared view of quality” in its new strategy for internal quality assessments.

In addition, Prof Richards claimed that the CQC and other regulators were moving towards “developing an approach to assessing the use of resources and efficiency” to “give a balanced picture of quality and use of resources for every organisation and acute trust in the country”.

GP concerns

Also in the inquiry, Prof Stephenson argued that the GMC, which warned today that doctors are struggling to find time to reflect in their practice due to huge workloads, was not built to cope with current rates of 10,000 complaints a year – and that a more streamlined system was needed to regulate individual medical professionals.

This could include “a common code” for all medical professionals who did something wrong, and dealing with complaints locally instead of taking doctors out of practice.

He also expressed doubt over health secretary Jeremy Hunt’s promise of an extra 1,500 places for medical students a year, arguing that they must lead to a “net increase” and not be used to replace doctors coming from outside the UK, and that it could lead to more generalist practitioners at the expense of fewer specialists.

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