Health Service Focus

07.04.17

60 seconds with… NHSI’s Ben Dyson

We talk to Ben Dyson, executive director of strategy at NHS Improvement (NHSI).

What are NHSI’s main policy objectives for the next 12 months?

Our core objectives remain the same: to support NHS providers improve their quality of care, financial performance and performance against NHS Constitution standards. To help us achieve all these objectives, we are leading an ambitious and ground-breaking programme of work to boost operational productivity within the provider sector. We also intend to continue our support to the sector on improving leadership and organisations’ improvement capability. Furthermore, together with NHS England and other national bodies, we’re supporting local health economies to work in a much more joined-up, collaborative way, in some cases radically reshaping the relationship between commissioners and providers to create models of ‘accountable care’ for local communities.

What are the biggest challenges facing the regulator?

Our challenges mirror the ones that provider organisations are facing. The NHS is doing a remarkable job in managing the continuing growth in demand for services, despite heavily constrained growth in funding. But this combination of growing demand and constrained resources is creating ever-growing risks, particularly when you add in the impact of workforce shortages and constraints on capital funding. Across the NHS, we need to be more systematic in identifying and rapidly spreading the most effective ways of improving quality and productivity and managing demand in more efficient ways. We in NHSI want to spend less time regulating and more time working with providers to stimulate and spread these kinds of practical, high-impact improvements.

How will NHSI’s relationship with STPs change and evolve as the plans develop?

As sustainability and transformation partnerships mature, they’ll get slicker at collective decision-making, allowing them to make faster and better decisions about how they use their collective resources – including their workforce, estates, technology and data – to get the best quality of care and health outcomes for their local populations. As this happens, we and NHS England will put increasing resources at the disposal of STPs. We will have a much more streamlined relationship with STPs, in terms of both oversight and support, and we will look to manage our relationship with the local NHS as far as possible through the leadership of these ‘accountable care systems’.

We’ve seen a number of trusts enter financial special measures – how is NHSI helping them?

There are currently 11 trusts in financial special measures, with two trusts having already exited the programme. We provide a dedicated team of specialists to help each trust identify the causes of the problem and create a plan that brings them back to sustainability. Under the programme, we provide challenge to senior leadership at trusts to make sure they are owning the issues and driving the necessary changes. We provide practical experience and tools to help finance teams implement best practice, including making sure that basic systems and processes (such as agency controls) are in place and working effectively. We help bring in learning from other trusts. And we bring in broader support on areas such as clinical productivity (Getting It Right First Time), nursing rota reviews and governance. In 2016-17, the programme identified around £100m of savings.

Agency spend has been reduced since caps were introduced, what else will NHSI be doing to tackle this issue?

Agency spending in 2016-17 was over £600m lower than in the previous year, which is a great achievement for the NHS. To build on this, we’re going to do more targeted work with providers that have high levels of spend, helping them understand what’s causing it and how they bring it down. We’re going to be focusing particularly on helping providers pay a fair price for medical locums, where we haven’t yet seen the same reductions as in other areas of agency spend. Providers are most effective in reducing spend when they have really good information to support their decision-making, so we’re working with providers to improve data collection and analysis, for instance collecting data on their top 20 highest earning agency staff.

What are the long-term aims of NHSI and how is the organisation likely to develop?

Our key long-term aims are to help provider organisations develop the leadership, improvement skills and relationships that allow them to drive continuous improvements in quality, health outcomes and productivity, with less need for regulatory interventions. To do this, we need to continue building strong relationships with the provider sector itself, seeking regular feedback on the quality of the support we offer. And we need to continue developing a more joined-up approach with other national bodies, removing any barriers that are getting in the way of effective collaboration locally.

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