Strictly under embargo to 00.01, Wednesday 20 June 2012

BRIEFING NOTE: NHS CONFEDERATION CONFERENCE 2012

This document covers the key points from the NHS Confederation’s 2012 survey of NHS leaders, as well as a viewpoint from Mike Farrar, the Confederation’s chief executive, ahead of his speech to the NHS Confederation conference in Manchester (20-22 June 2012).

KEY POINTS FROM 2012 SURVEY OF THE LEADERS OF THE NHS

The survey covers 252 chairs and chief executives from 200 healthcare organisations, all members of the NHS Confederation. Responses came from the heads of acute trusts, primary care trusts, ambulance trusts, mental health trusts and independent sector providers of NHS care.

PART ONE – THE CURRENT SITUATION

HEALTHCARE CHIEFS SAY THE FINANCIAL POSITION IS VERY SERIOUS

Looking at their current financial pressures, 28 per cent described the current financial position as “the worst they had ever experienced”. An additional 46 per cent said the position was “very serious” while five per cent thought it was “better”.

Providers of healthcare, such as NHS trusts, felt the pressure most strongly. Seventy six per cent of respondents from providers said the pressure was “the worst they had ever experienced” or “very serious”. This compared to 64 per cent of respondents from primary care trusts.

[See bar chart]

THE PRESSURE IS GREATER THAN 12 MONTHS AGO AND IS SET TO INCREASE FURTHER

A majority, 53 per cent, said financial pressures facing their organisation were worse or significantly worse than 12 months ago. Just 11 per cent thought they had improved or significantly improved. And some 85 per cent expect financial pressure to increase over the next 12 months.

[See bar chart]

MANY SAY CARE HAS BEEN AFFECTED, PARTICULARLY THE EXPERIENCE OF PATIENTS

Asked which areas of patient care had been most affected by the financial pressures on their organisations over the past 12 months, 42 per cent said experience of patients, 35 per cent said waiting times and 17 per cent said the availability of treatments and drugs. Just over a third, 34 per cent, said care of patients was not affected.

[See bar chart]

THEY EXPECT TO SEE THE IMPACT ON CARE SPREAD OVER THE NEXT YEAR

Asked to predict the areas of patient care that would be most affected over the next 12 months, respondents highlighted the same issues in greater numbers. Sixty three per cent said patients’ experience would be most affected, 49 per cent said waiting times and 30 per cent said availability of treatment or drugs. The proportion feeling no care would be affected fell to 15 per cent.

[See bar chart]

THERE IS ALSO SERIOUS CONCERN ABOUT THE OUTLOOK FOR PATIENT CARE NATIONALLY

Asked about the outlook for the quality of care across the NHS as a whole over the next 12 months, 47 per cent predicted a decline, 15 per cent thought it would improve and 38 per cent felt it would stay the same. NHS foundation trusts were slightly more likely to believe quality would improve.

[See bar chart]

CUTS IN LOCAL AUTHORITY FUNDING HAVE ADDED TO THE PRESSURE

Two thirds of respondents (66%) said that cuts in local authority spending had impacted on their services over the past 12 months - a further 18 per cent said they may have done.

Of those who felt there had been an impact from the cuts, 92 per cent said there were more delayed discharges from hospital, 87 per cent said there was greater demand for community services, 76 per cent pointed to more demand for mental health services, 57 per cent said there were more acute admissions to hospital, 55 per cent said there were more A&E attendances and 50 per cent said there were more emergency readmissions.

[See bar chart]

MANAGING THESE FINANCIAL PRESSURES WHILE ALSO MEETING THE NEEDS OF AN OLDER POPULATION WILL BE THE BIGGEST CHALLENGE FOR THE NHS OVER THE NEXT DECADE

Healthcare leaders were clear that demands on the NHS will increase over the next decade. The commonly cited challenges were care of the elderly (42%) and pressure on finances (42%). These were followed by increased demand (33%), growth of long-term conditions (32%) and managing the expectations of patients and the public (32%).

[See bar chart]

PART TWO – THE RESPONSE

THERE IS STRONG CONSENSUS THAT RADICAL LONG-TERM ACTION IS NECESSARY

Looking at the changes necessary for the NHS to respond to financial pressure and improve the quality of services, healthcare leaders were clear about what needs to happen. Seventy seven per cent highlighted integration of care and 63 per cent said expand community-based care.

This would allow for a reduction in the size of the acute hospital sector. Thirty one per cent said there should be concentration of specialist services, 28 per cent said close whole hospitals and 15 per cent said close some services. In addition, 28 per cent said invest in self-care.

The most commonly cited priorities for improving the quality of care over the next 12 months were increasing the integration of care (73%), the faster spread of innovation (49%), and the development of stronger leadership (39%).

[See bar chart]

IN THE SHORT-TERM, THE NHS IS MOSTLY RESPONDING BY CUTTING COSTS

At this early stage in the financial year, most healthcare leaders expressed some confidence in meeting efficiency targets (QIPP/CIP) over the next 12 months.

Respondents from organisations providing care – NHS trusts and NHS foundation trusts – most commonly planned to do this by rationalising estates and assets (43%NHS trusts/37% foundation trusts) and by reducing management and administration (32%/33%).

Respondents from organisations commissioning care –primary care trusts – most commonly planned to do this by reducing management and administration (33%) and by expanding community-based care (31%).

In general, however, the survey suggests there may be only limited progress on addressing the long terms issues over the next 12 months.

Asked about barriers to making efficiencies, many highlighted resistance to change - 26 per cent said political resistance, 16 per cent staff resistance. Concern about resistance was greatest among respondents from non-foundation NHS trusts.

In addition, 22 per cent highlighted cuts in local authority funding and 15 per cent said failure of organisations to cooperate locally. This demonstrates the importance of whole-system solutions rather than changes that benefit one part of the system over another.

[See bar chart]

WHATEVER THE BENEFITS OF THE GOVERNMENT’S REFORMS, THE PROCESS OF TRANSITION HAS ADDED TO THE RISKS FACING THE NHS

Asked to name the risks to the government's NHS reforms, the most commonly highlighted issues were: lack of expertise or experience in the new organisations (cited by 57%); disruption due to organisational restructuring (cited by 54%); financial pressures of cost saving targets (cited by 54 per cent); and a lack of system management (cited by 46%).

[See bar chart]

CONFIDENCE VARIES IN THE READINESS OF PARTS OF THE NEW NHS SYSTEM

Respondents were asked how confident they were that different parts of the new NHS system would be ready to effectively discharge their responsibilities in 2013.

They were most confident about the readiness of Monitor in its new role as an economic regulator. Sixty eight per cent said they were confident compared to 31 per cent who were not confident, giving a positive balance of 37 per cent. Other organisations with a positive balance were NHS Commissioning Board (plus 28%) and the NHS Trust Development Authority (plus 16%).

There was most concern about readiness of Healthwatch and the Care Quality Commission (Healthwatch will be hosted by the CQC). Eighty per cent of respondents said they were not confident about Healthwatch compared to 11 per cent who were confident, a negative balance of minus 69 per cent. Sixty nine per cent said they were not confident about the CQC compared to 31 per cent who were confident, a negative balance of minus 38 per cent.

NHS leaders also commented on the readiness of bodies responsible for public health and local commissioning. On public health, they highlighted health and well being boards (minus 35%), local authorities (minus 28%) and Public Health England (minus 11%). On commissioning, they highlighted both clinical commissioning groups (minus 26%) and commissioning support services (minus 21%).

[See bar chart]

HEALTHCARE LEADERS WANT THE GOVERNMENT TO BACK THEM IN ADDRESSING LONG-TERM CHALLENGES FACING THE NHS

Asked how the government could help the NHS implement the reforms, the most commonly cited responses concerned ending top-down interference, supporting NHS leadership, backing integration of care and reconfiguration of services, as well as acknowledging the financial pressures.

METHODOLOGY

The NHS Confederation asked the Picker Institute Europe to survey the chairs and chief executives of all its member organisations.

The survey was conducted between 26 April 2012 and 16 May 2012. It was sent to 625 chairs and chief executives in 362 organisations. There were 252 completed surveys - a response rate of 40 per cent - from 200 organisations.

PART THREE – NHS CONFEDERATION VIEW

Mike Farrar, the Chief Executive of the NHS Confederation, says:

“Despite huge efforts to maintain standards of patient care in the current financial year, healthcare leaders are deeply concerned about the storm clouds that are gathering around the NHS.

“Our survey shows that many see finances getting worse and that this is already having a growing impact on their patients. In response, they are cutting costs in the short-term but they know that much more radical solutions are the only answer in the long run.

“Frankly, without action on the way we provide health and social care, the NHS looks like a super-tanker heading for an iceberg. The danger is clearly in view and looming ever larger. We know what needs to happen. But are we going to be able to take the assertive action needed in time?

“The debate about changes to healthcare has focused on hospitals, but what we are talking about is more radical and fundamental than this. The NHS needs a wholesale change in approach.

“It needs to engage patients as people with an active role to play in improving and maintaining their own health, not passive recipients of care. It needs to empower and support carers properly. It needs to expand services like community pharmacy, improve public health, and help patients with chronic disease manage their conditions.

“Clinical commissioning groups will need to design new services that cross the old divides of primary and secondary care, and health and social care. This means providing more services in the community, genuinely integrating care and doing more to get the best from our talented staff.

“The NHS must explain the importance of consolidating some of our acute services into centres of excellence to improve outcomes for patients, while also caring for more people out of hospital when they could be better and safely cared for in their own homes.

“These are all actions which our leaders know could and should be taken.

“But there has been a failure to explain what we need to do to maintain and improve standards of care while keeping the NHS affordable at a time of austerity. Our survey comes hard on the heels of a reported dip in public confidence about the NHS. This suggests that the man and woman in the street have become confused and worried about what is happening in the NHS.

“NHS leaders surveyed are clearly worried about standards of care. They associate this with: the tight financial position; the even tighter financial position faced by local authorities; the distracting effect of the reforms; the time that it will take the reforms to bed in; and the chronic failure of political leadership to secure the public support for the changes they know are needed.

“It is clear that what the NHS desperately needs is public support for planned change to services.

“But politicians have consistently failed over many years at national and local level to put the long-term interests of their population’s health above their short-term electoral interests. They have suffered further setbacks to their credibility with reforms focusing on organisational and structural change, rather than creating the right environment for change to services.

“On top of this, senior leaders in the NHS itself have become increasingly distracted by the transitional arrangements for the new system and have not been able to set out their vision and strategy for change.

“NHS leaders fear that the new organisations at local level will take time to bed in and that the bureaucracy created by the new system could kill the enthusiasm of its new leaders. They worry that the new national bodies splintering out of the Department of Health will struggle to align their policies and incentives so that the NHS can make coherent sense of them.

“The NHS will get on and do its upmost to make things work for patients. But we do not have the luxury of time if we are going to make the right changes to services. Health and social care leaders must come together now and speak about these issues with one loud, strong voice.

“We all – clinicians, healthcare and local government managers – must take on the leadership role and ensure the public are with us. That will mean speaking plainly and clearly. For example, when we talk about changing hospital services we mean providing better care for people with dementia. When we talk about ‘integration’ we mean joining up care for children under the age of five.

“We must also behave differently ourselves. We must always think and act as part of integrated health and social care communities. We must work in the interests of the health of the population, not just in the interests of a particular institution.

“If we don’t achieve the changes we need to make, the financial pressures will eventually overcome us. Change will still come about, but through unplanned catastrophic failures. All this would hugely damage public confidence and waste precious resources. Far better to set out and get support for the changes we need to make, then move swiftly to help providers plan and implement them.

“I genuinely believe we can achieve a better – and sustainable – NHS, but as the survey suggests we face a mighty struggle unless we take the necessary steps as soon as possible.”

FURTHER INFORMATION:

Contact Francesca Reville 020 7074 3312 or 07884 473086 or Niall Smith 020 7074 3304 or 07767 770309 or Mike Foster 020 7074 3308 or 07872604108.  For out of hours media enquiries, please call the Duty Press Officer on 07880 500726.