Challenges faced in the English health service

New proposals in the health service in England would push the majority of all health service commissioning through GP commissioning groups, with the remainder going to a national commissioning board which would commission high specialty services, Mr. Stuart Bain, Chief Executive, East Kent Hospitals University NHS Foundation Trust, told the HMI Conference. Maureen Browne reports.

Mr. Bain said that prior to the Blair years there had been a low spend on health. The new reality was an ageing and growing population, the burden of long term conditions, and increased burden of regulation, more competition, greater complexity in commissioning, more demanding consumers.

Mr. Stuart Bain, Chief Executive, East Kent Hospitals University NHS Foundation Trust addresses the HMI Annual Conference 2012
Mr. Stuart Bain, Chief Executive, East Kent Hospitals University NHS Foundation Trust addresses the HMI Annual Conference 2012

They were also facing the challenge to treat more people while taking money out of the system – 20 per cent efficiencies were being sought over four years.

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There were different systems for delivering healthcare in England, Scotland, Wales and Northern Ireland and his address dealt with the system in England.

Up to this year the system management consisted of ten Strategic Health Authorities, – now clustered into four geographical regions, a Shadow National Commissioning Board, 50 PCTs (clustered) and 227 Shadow GP Commissioning Groups.

Service delivery was through the NHS Trust, Foundation Trusts, Community Providers, the private sector, the voluntary sector and community interest organisations.

However, new commissioning proposals would push the majority of all commissioning through GP commissioning groups, with the remainder going to a national commissioning board which would commission high specialty services.  There was still confusion as to what would fall into national and local commissioning groups.

The new structure provided for the Health Department, a National Commissioning Board, Clinical Commissioning Groups and mixed economy providers. Eighty per cent of the funds would go to the GP Commissioning Groups.

Hard edged targets are essential, we need system accountability and financial levers, public accountability helps, we need to move towards ‘standards’ from ‘targets’ and remember it’s all about the patients’ experience.

Foundation Trusts had to provide a downsize scenario, with provision for a six to seven per cent cut budget cut for the following two years. “This is extremely tough but you have to do it to become a Foundation Trust. You have also to show that you are legally compliant and well governed.

Governance arrangements in a Foundation Trust provided for Foundation members, Foundation Trust Governors, Non Executive Board Directors, Executive Directors and Divisional business units.

The key strands of performance management were:

  • National Policy Context – Department of Health
  • System Management – Strategic Health Authorities
  • Independent Regulation – Care Quality Commission/Monitor etc
  • Clinical Guidelines (NICE, Royal Colleges)
  • Professional Standards and Regulation – GMC, NMC etc
  • Educational Accreditation – (PMETB/GMC and Deaneries)
  • Targets & Standards – National and Local
  • Financial Penalties & Incentives – Primary Care Trusts /GP Commissioners

Mr. Bain said the management philosophy was based on clear performance standards, earned autonomy and delegated decision making.

Challenges faced by the service were money versus quality, public accountability versus focussed business acumen and targets versus standards.

“Good management is essential. As leaders and mangers recognise it is the people who deliver and when you have good people well led and well motivated, you have great services.”

Mr. Bain said he thought it was part of the role of senior managers to provide space and the ability for people with energy and ideas to change the service focus.

He said he was very keen to have real time information to drive decision making – if you don’t it’s like driving a fast care, looking through a rear view mirror.

“Hard edged targets are essential, we need system accountability and financial levers, public accountability helps, we need to move towards ‘standards’ from ‘targets’ and remember it’s all about the patients’ experience.”