10 quick reflections on... 2016

23 December 2016

10 quick reflections

Amber Davenport

It has been quite a year. Some shocking events have taken place across the world and I think it is safe to say that many will be pleased to see the back of 2016. The NHS has had its own series of ups and downs this year and below are my reflections on how some of the main events have affected the NHS and trusts over the past 12 months.

1. The EU referendum result in June was unexpected and while no-one is quite sure what Brexit will bring, the possible implications for the NHS could be considerable. The elusive extra £350 million has not yet made an appearance, however concerns around workforce, access to medical research and innovation are beginning to come to the fore. The NHS is not at the top of the government’s Brexit considerations, and from the conversations I’ve had it seems that the Department of Health will be preparing for its own negotiation with No.10 in order to raise the NHS up the priority list. The outcome of the EU referendum also resulted in a political whirlwind for a good few weeks and brought about the appointment of Teresa May as the new prime minister, and with her came a new cabinet. However, some helpful stability remained as Jeremy Hunt was reappointed as health secretary, becoming the longest serving health secretary since the establishment of the NHS. 

2. Following a £2.5 billion deficit at the end of 2015/16, the financial challenge facing trusts continued to dominate throughout 2016, with the national bodies launching a financial ‘reset’ in the summer, introducing financial special measures and control totals for both CCGs and trusts. In response, trusts have redoubled their efforts to tackle the deficit and the Q2 figures demonstrate the impressive progress that has already been made. Had the trend in deficit increases continued, we could have expected a provider deficit of nearly -£2.4 billion in the second quarter of 2016/17. However, supported by £900 million of sustainability funding, trusts have delivered a Q2 outturn of -£648 million. We will wait for Q3 and Q4 figures with baited breath, hoping that back-ended cost improvement plans and front-loaded sustainability funding won’t mean that the scale of the financial challenge has just been pushed back into 2017. We will also continue to highlight the need for a long term solution for healthcare funding, as we did this year through our evidence to the House of Lords committee on NHS sustainability.

3. Sustainability and Transformation Plans (STPs) quickly became the new show in town in early 2016. All 44 plans have now been submitted and published. The process was tricky and the timeline ambitious, but the sector should be proud that all partners have worked together at a local level to consider how they can overcome challenges and deliver health and social care that is fit for purpose for their local population. It remains to be seen whether the plans will deliver the expected financial savings and the key challenges and priorities in 2017 will be for the centre to invest in the plans and for local areas to begin delivery while undertaking meaningful engagement and consultation with their local communities. This is critical for successful implementation. 

4. April saw the launch of NHS Improvement – the coming together of Monitor and the NHS Trust Development Authority. At NHS Providers we have been impressed with the progress NHS Improvement has made in adopting a new approach to regulation. The single oversight framework presents an opportunity for the regulator to be pragmatic in the way it oversees trusts, taking into account their contribution to wider health economy challenges and delivering strategic change, rather than being used as a blunt regulatory tool which penalises trusts for taking risks. The CQC also launched a consultation this week on its new regulatory model, proposing fewer inspections and more co-regulation. These changes are welcome and we will be exploring trusts’ experiences of regulation over the last 12 months through our annual regulation survey. The results of this survey will be published in March 2017.

5. It has now been over two years since the Five Year Forward View (5YFV) was published and the new care models programme really took off in 2016. NHS Improvement accredited the first trusts that can act as ‘group leaders’. NHS England published contracting frameworks for multispecialty community providers, primary acute care systems and care homes and the new care model programme recently awarded over £100 million of funding to vanguard sites. 

6. The 5YFV mental health taskforce published a report which focussed on the importance of prevention in creating a nation with improved mental health, with a focus on improved access for crisis care and home treatment services. The report also focussed on a continuing need for parity and investment in order to accelerate improvements and share the learning from successful mental health care models. Such an ambitious programme, with a clear implementation plan, is a real milestone for mental health services. 

7. As explored within our recently published The state of the NHS provider sector report, despite great delivery and a huge effort by the frontline, the sector is struggling to meet national operational targets. Delayed transfers of care are now at a record high and only 12 trusts meeting the four hour A&E waiting time target in Q2 2016/17. However, in reality, given that demand is increasing at such a quick rate (NHS Improvement reported that emergency admissions via A&E were 4 per cent higher in July-September 2016 compared to last year), it is likely that trusts are actually seeing more patients in A&E within four hours. But we are now getting to the point where the scale of demand is outstripping efforts to improve performance and overshadowing the progress made. 

8. Over the summer the NHS experienced a turbulent time while junior doctors undertook the longest and most severe period of industrial action, resulting in several complete walk-outs including a withdrawal of urgent and emergency care delivered by junior doctors. Despite this strike action and ACAS negotiations, a phased implementation of the new contract began in October. The focus will now turn on to trusts with increased scrutiny on how they are implementing the contract in a safe way at a local level. 

9. The pressures in primary care and social care have worsened over the past year, to the point where the CQC described social care as being at a tipping point in their annual State of Care report. We and other commentators called for extra funding for social care and primary care to alleviate pressure on NHS trusts, but this wasn’t delivered in the Autumn Statement. With this lack of investment, the extra funds promised through NHS England’s GP forward view, the local government precept and Better Care Fund look insufficient to deal with expected demand. Next year is set to be even tougher for that area of the sector. At the same time however, trusts have been supporting their local partners in these areas and are working together to develop innovative solutions to tackling the challenges, such as in Tameside and Oxford. 

10. Throughout the year it became clear that if the NHS is going to overcome challenges and continue to deliver, then we can’t forget about our leaders. A new leadership strategy, which aims to boost diversity and clinical experience, was published. And Jeremy Hunt took the opportunity to launch a number of new leadership and strategic workforce initiatives at our annual conference and exhibition in November. These included an NHS MBA, details on the nursing apprenticeship scheme and a GP retention pilot.

What a year. I spent six months of it on secondment to one of our member trusts, working on a transformation project, so while I wasn’t actively involved in national policy for a while one of my take homes from that experience was that policy change does not affect the NHS in isolation. Instead, piecemeal policy change has a cumulative impact and affects every layer of the NHS – from board to ward to project teams.

Bringing everything together in the way I have just demonstrates the huge amount of national policy and political change during 2016. It hasn’t even begun to cover the local complexities NHS trusts deal with day in and day out. Despite this volatility, the sector has responded in an agile and pragmatic way – you all have a lot to be proud of. Now roll on 2017, we’re ready for you.