Key challenges facing the NHS - what does this mean for scrutiny?

Last updated:07 April 2010

Healthy Accountability Forum March 19th 2010

Introduction

The Forum is an opportunity for Members and Officers involved in health scrutiny to meet face to face with policy makers. It represents the best in what is going on in the Regions, debates and influences current issues and policies affecting health scrutiny, shares knowledge and information.

 At this meeting the Forum discussed how scrutiny might tackle local NHS plans to meet predicted future challenges, to ensure that the aims and objectives set out for the health service can still be achieved for their local populations. 

Setting the Scene
Key Challenges facing the NHS

Vince Roose, Head of Public Engagement in the Public and Patient Experience and Engagement team at DH, opened the Forum by concentrating everyone’s minds on what the Key Challenges Facing the NHS are.  The NHS needs to improve efficiency and productivity, reduce demand and capacity, and cut costs by £15bn to £20bn. It is predicted that there will be a two thirds increase in the numbers of people over 80 by 2024, and by 2050 50% of the population will be clinically obese. The NHS ‘simply can’t just do more of the same to meet these challenges. The Wanless ‘crunch’ point has arrived. The challenge starts 1 April 2010 - expect a large volume of service reconfiguration in next 24 months’

Elizabeth Wade, author of the  NHS Confederation publication  ’Commissioning in a Cold Climate’, described the policy and financial implications for PCTs tackling the challenges. If for example by operating more efficiently, providers simply achieve a higher return, create capacity to see more patients, or shift costs to another part of the system, it does nothing to help reduce expenditure.  PCTs will need to actively de-commission services, sometimes re-commissioning different ones, in line with plans to reduce demand.  They must find opportunities through Improving Quality, Innovation, Productivity and Prevention (QIPP) to do things differently and better in all healthcare sectors. Frances Blunden, author of the recent NHS Confederation publication ‘The Heart of the Matter’, said PCTs and Trusts must ensure the public, politicians and service users are engaged in developing and implementing those strategies. 

Alyson Morley, LGA Senior Consultant, in describing the ‘Local Government Policy Landscape’ told the Forum no matter who wins the election there appears to be little difference in NHS policy between the parties, and the over-arching issues of locally integrated service delivery, Total Place, the Marmot Report findings on health inequalities, and the future of LINks and HOSCs will remain firmly in the picture and need to be taken into account.
 

Debate
What does this mean for Scrutiny?

The discussion that followed identified four main areas which the panel were asked to respond to; the integration of practice based commissioning; the relationship of HOSCs with clinicians and others; the various balances to be struck between optimising clinical outcomes and local provision; the need for HOSCs to develop collaborative working in lean times.

Clinical engagement

Given that PCT Professional Executive Committees are beginning to reflect local Practice Based Commissioning (PBC) groups, that presents a significant opportunity to develop PBC to meet the NHS challenges in general and the local JSNA targets in particular. Overview and Scrutiny historically has built relationships with PCT and NHS Trust managers and it was suggested that HOSCs might seek a broader and deeper relationship with clinicians to seek first hand clinical evidence and opinion alongside the more traditional dialogue with managers.

Trust

Embedding the culture of Patient and Public Engagement in the NHS needs to include clinicians as much as managers. The historic HOSC relationship with PCTs is based on mutual trust, but under pressure transparency and openness can suffer. There are many current examples of the integration of community services into Foundation and other Trusts where the management of change could have been smoothed with pre consultation discussions based on trust.  The quality of involvement is patchy and dependant on local leadership.
 
Balance

In health service redesign and reconfiguration there can be what can be described as a trade off between top level clinical outcomes and other considerations for the patient such as local accessibility and quality of life, which is not the same for everybody. It is important to understand how this plays out in local populations, and HOSCs clinicians and managers can use the scrutiny process to find out.  Performance measures need or should not only be about outcomes, but could be about communication and choice. The personalisation of healthcare budgets presents an opportunity to look at all this differently, because good choices and information can not necessarily be judged by the outcome. 

Collaboration

The anticipated lack of resources in the public sector will also affect scrutiny.  HOSCs need to build relationships with each other and work collaboratively on sections of their agenda, having made local choices on the priority given to reconfigurations, health inequalities, and commissioning, for example.   It was asked when the long awaited Guidance might appear and although it is hoped this could be as early as July all depends on the direction the new government wants to take scrutiny.

Next Meetings

The Forum will meet again on June 21st, September 20th and December 16th at Local Government House. The Forum consists of a Health Overview and Scrutiny Committee support officer and councillor representative from each NHS regional health scrutiny network, with colleagues from Health and Social Care. There are some additional places for Committee chairs  available by contacting avril.davies@cfps.org.uk