27.10.16
‘Rapid progress’ needed on payment systems to fund FYFV reforms
Funding promised to deliver the reforms to the NHS in the Five Year Forward View is being diverted to address existing financial shortfalls, the King’s Fund has warned in a progress report published today.
Of the £2.16bn sustainability and transformation fund available for 2016-17, £1.8bn is being used to cover provider deficits. The think tank argued this raised concerns that sustainability and transformation plans (STPs) were being drawn up without the available funds to deliver them, with just £300m left to invest in new services.
Chris Ham, its chief executive, argued that the future of the NHS depends on being able to implement FYFV changes. While new care models “hold out the prospect of moderating rising levels of demand”, such as through better integration, they still require time and investment – both of which are “currently in short supply”.
“National leaders should hold their nerve, continue to support innovations now well under way, and work to remove legislative and policy barriers to progress,” he continued.
“By ring-fencing £1.8bn for the next two years to reduce deficits, national NHS bodies are effectively leaving the NHS without the investment needed to deliver the transformation of services set out in the Forward View.”
The report stressed that NHS England and NHS Improvement need to make “more rapid progress” in the development of payment systems to support new care models, such as capitated budgets, pooled budgets and integrated personal commissioning; in the regulation of care systems and their organisations; and in the use of contracts to support primary and acute systems and multispecialty community providers.
“The law on procurement and tendering also needs to be clarified to avoid unnecessary delays and cost in implementing new care models,” it said.
STP governance
With regards to STPs, the King’s Fund argued that is “essential” to strengthen their governance in order to ensure that footprints can make decisions collectively while holding constituent organisations accountable, since they have no statutory basis.
The think tank said each STP area should identify a leader who can commit to fully working on the plans alongside a team, then support these individuals’ professional and personal development. This should be backed up by clear and consistent leadership from regulators and other national bodies.
It also called on national bodies to ensure that adequate funding is in place to support vanguards and STP footprints, potentially by raising capital from new resources or releasing resources from the NHS estate.
Vanguards and new care models
NHS England has now selected its multispecialty community provider (MCP) and primary and acute system (PACS) vanguard sites to deliver new models of care, but the King’s Fund said there has been mixed progress in implementing them. For example, no contracts will be let to MCPs until April 2017 at the earliest.
The report said vanguard sites could fulfil their promise with more time and support, including robust organisational and clinical governance.
In addition, it argued that national bodies need to urgently clarify what the legal requirements are for vanguard sites with regards to procurement and tendering.
Separately, the report warned that the CQC could be inhibiting reforms if its inspections were used to assess providers’ suitability to lead new care models.
It said the regulator should use a forthcoming consultation to discuss how it will assess whole systems of care.
A Department of Health spokesperson said: "As this report shows, the NHS has a strong plan to transform services and progress is being made.
"We know some parts of the NHS are under pressure financially - that's why NHS Improvement is providing intensive support to hospitals to help them get finances back on track and we're giving an extra £10bn per year by 2020 to ensure services are fit for the future.”
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