Faster reconfiguration of NHS services is needed for next two years says NHS chief

BMJ 2012; 345 doi: (Published 19 September 2012) Cite this as: BMJ 2012;345:e6334
  1. Adrian O’Dowd
  1. 1London

Reconfiguration of NHS services will have to speed up over the next two years to deal with the failure so far to shift sufficiently the focus of care from acute to primary care settings, MPs have been told.

England NHS chief executive David Nicholson said one of the government’s main objectives to treat more people in community settings rather than in hospitals was not working well enough.

MPs on the parliamentary public accounts committee were quizzing Department of Health officials as part of their inquiry into NHS trust financial resilience, prompted by the National Audit Office (NAO) report Securing the future sustainability of the NHS,1 published in July.

Committee chair Margaret Hodge, Labour MP for Barking, asked for the latest statistics on hospital admissions, given that all the government’s NHS reforms were based on the assumption that the number of people admitted to hospital would fall as more people were treated in the community.

Nicholson said that although emergency admissions had fallen by about 1.7% during 2011-12, they had started to rise again and for the first part of this financial year had risen by between 2% and 3%.

“In most cases, reductions in referrals have been around the use of data, the use of benchmarking, and people thinking about individual decisions—GPs in particular. It hasn’t resulted in significant amounts of reconfiguration.

“In order to sustain that position, we think that for the last two years of the spending review [2013-14 and 2014-15], there needs to be significantly more reconfiguration of service in order to be able to deliver that objective.”

Persuading people not to automatically go to accident and emergency was a “difficult thing to do”, he admitted, adding: “But that is not to say that change isn’t happening.

“We are persuading people and they are making the change, although not fast enough, we don’t think, in order to deliver. We believe the development of NHS 111 [the urgent care phone service] sometime next year will be a significant step forward in all of that.”

The National Audit Office report said the NHS had delivered a £2.1bn (€2.6bn; $3.4bn) surplus in 2011-12 but there were financial problems in some NHS trusts and a large gap between the strongest and weakest organisations.

It concluded that without direct financial help, some trusts might not have broken even, or would have reported larger deficits.

Turning her attention to fellow witness David Bennett, chief executive of Monitor, the independent regulator of NHS foundation trusts, Hodge asked: “There is a lot of one-off money that still goes into the system—about a billion pounds a year—to rescue hospitals that would otherwise go into deficit across the piece. How many of those with foundation trusts status would be in deficit if they did not get these one off payments?”

Bennett said: “There is a question as to whether more trusts would be in deficit if there weren’t some of the one off payments.

“However, there is no information collected as to why these one off payments are made. Maybe all of it is entirely legitimate.

“For example, if there is an agreement between a trust and a commissioner that if the level of activity that the trust is asked to undertake is greater than that written into the contract, then the commissioners will pay for the extra activity.”


Cite this as: BMJ 2012;345:e6334


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