Editorial Wednesday 21 May 2014: Notes from Simon Stevens & Jeremy Hunt's speeches at NHS Clinical Commissioners

Below are my semi-finished notes from the NHS Clinical Commissioners conference appearances by Simon Stevens and Jeremy Hunt. Drawn from my tweets, so a bit rough in places, but hopefully of interest.

Simon Stevens live at NHS Clinical Commissioners Annual Conference
NHS England’s new chief executive was introduced by NHSCC president Charles Alessi, who told delegates “Simon Stevens has come home”. (Like football in 1996?)

Simon Stevens: It’s no exaggeration to say the future success of NHS will in large part come down to clinical commissioners. No pressure, then.

You could say this is the first birthday of CCGs, or it’s 23rd birthday after the 1991 purchaser-provider split. No time for displacement activity. Time to roll up our sleeves. And think King James Bible – ‘by their fruits shall ye know them’. It's about clinical commissioners' performance.

The NHS is doing well, but we must be honest that in parts, a lot’s not working as it should. In a poorer part of Birmingham I visited this morning, in many respects health was not being improved by the health and care system; health outcomes are worse than in better-off areas

There are three foundational things to get right for CCG success. First is involvement. As stewards of 2/3 of the NHS budget, clinical engagement of your members is crucial. Do CCG members feel able to shape CCG activity, and can you make a difference to what the NHS does?

Secondly, is actionable data in your hands? Data and informatics clearly has some way to go – and this needs huge amounts of work quite soon. To commission effectively, you need fantastic actionable information.

You also need to find ways enable CCGs take more holistic view of clinical decisions across your local area. To properly integrate care outside acute settings, you need to consider various factors including your input in specialist commissioning to help put NHS on sustainable path.

This is about local solutions. No one size fits all. But all change plans must be grounded in the context of the five-year strategic reviews. We are planning no structural reorganisation, but want to hear in which areas you want more clout.

That includes the commissioning of primary care. NHS England want to support and assure this, and to work with CCGs who are interested in this area around co-commissioning - both of primary and specialist care.

Clearly, we need you to successfully conclude 2014-15 commissioning round with attention to realistic activity levels funding for this year. There is going to be real pressure. Pay attention to mental health and seize the win of Improving Access to Psychological Therapies – a crucial area for continued progress.

So please use May to really stress-test your plans for the Better Care Fund with your HWBs. Better an honest conversation now on what's realistically achievable than in December when big problems could arise. Please ensure realism on this by having your acute provider in the tent and having realistic conversations with them about preventing emergency admissions now rather than come winter.

By the autumn, the NHS needs well-thought through articulated view on what's required to make NHS sustainable for the next five years. It’s very important for national conversation about where NHS needs to head. Thank you all for all we are doing: we're banking on your success

Q&A
SS: across NHS, suffered from pretending uniform admin structures equals delivering high-quality care. solutions must be locally tailored.
SS: don't think will be 211 different models - patterns will emerge. HWBs as locus for joint commissioning agree but must be real.
SS: massive overspend on specialist commissioning took money from CCGs. must prevent a repeat, & @NHSEngland can't act alone; need CCG help
SS "to will the end is to will the means" in our gift to change stuff we want to change. Agree competition should be in patients' best interest
Q from delegate about how little has changed behaviourally to date in NHS England from under the old system
SS: some of that's fair, some not. specialist commissioning fair point; alignment and other issues and can do better there. How do better?
SS: do better by working with you. @Jeremy_Hunt arrives.
Michael Dixon has worked with/under/in/on several Secretaries Of State: @Jeremy_Hunt is one of very best. No mention of #SimonBurns4SOS

Health Secretary Jeremy Hunt
Jacket off and no lectern as Jeremy Hunt thanks delegates for all their hard work. I'm not a clinician. Commissioning led by GPs best-placed to address LTC care. Remember the Act controversy, opponents would be shouting of failures, but ain't been the case. Reforms, which were incredibly controversial, and I know we couldn't raise £ much but activity has still been rising.

Dismantling PCTs and SHAs meant we could fund 7K more doctors and 2K more nurses. I've never seen people work as hard in the private sector as I’ve seen in the NHS.

People are asking is NHS sustainable as it is? Not alone in reviewing. In US, also reviewing sustainability of health systems, and internationally.

Hunt: principles motivated us to be first country in world to do universal health coverage to best there is regardless wealth, no reason we should compromise on those core principles. And work with Simon to ensure deliver on that. Took US to 2012 >universal coverage we did in '48

Can only keep NHS as is if base decisions on these three reform principles: 1. whatever financial and other pressures, never compromise on care quality


NHS staff say there are still pockets of mid-staffs practice, wasnt a one-off. difficult lifting bonnet on problems. 15 hospitals (10% of acute trusts) are in special measures. but they're getting better. Basildon, I asked what's changed; the listen to us, and have ‘Onion’-style meetings (cc @SamanthaJNHS) Basildon CE now does daily in cafe. Leading world in transparency revolution. Was telling China’s health minister!
J Hunt: 2. Moving care out of hospitals - this is very revolutionary stuff, will lead to higher quality care being delivered. I'm delighted Simon Stevens shown commitment to revolution of out-of-hospital care. For LTCs, current model fundamentally not well-suited.

Commissioning led by GPs best-placed to address LTC care. Remember Act controversy, opponents would be shouting of failures, but ain't.

We know there are concerns over Section 75 and competition issues, we'll sort them out. We have people @ grass-roots itching to integrate services. Great!

We have great advantage in NHS is our tradition of general prcatice, but haven;t made the most of it At heart of the changes we need, restore trust between patients and doctors. Removed 1/2 QOF targets, want to do more. Simon announced and I challenge you: be guiding lights in your areas to create the out-of-hospital plans. You know what's happening and can persuade other doctors of what has to happen. And please include your acute trusts, so it doesn't seem dastardly plot to take out activity and funds to discomfort them. Know no other country trying to revolutionise out-of-hospital care. and three, we must be really welcoming of innovation. We have 100% EPR in primary care: good starting point, but can build from there.

Finally, joke re 'no other cabinet minister jealous of my job'; Reagan ‘sleepless afternoons’ gag and Churchill success ability to go from failure to failure without losing your enthusiasm.

Q&A
Q on how to resource proposed freedoms in primary care a bit quicker; it's dropping

Q; What will you put a GP on the @NHSEngland board? Simon S: apply for NED jobs!

SS: there is no more £, so how more funding for primary care involves stop spending £ on bad for patients care and CCGs choosing. NAO found 124% rise in patients admitted to acute as emergency for 1-2 days, and that's system failures of integration espc for frail older people

Jeremy Hunt: Better Care Fund is a big gesture to out-of-hospital care and £5 added onto primary care global sum. also about your leadership.