Comment: First steps towards the future
By Steven Peak, business development director, Vanguard Healthcare
NHS England has announced how the budget for the Health Service will be allocated over the next five years. The implications are enormous and it seems NHS England is clearly setting out a method to syndicate widely the progress made by Vanguard sites. In this article, Steven Peak of Vanguard Healthcare asks how trusts can deliver what is expected of them, suggesting that a flexible approach to care facilities could be the key
The allocation of funding for the NHS is evidence of the expectation that strategic integration will occur between commissioners and providers – a significant milestone for place-based healthcare provision. Among the announcements are increased spending on GPs and primary medical care and an average rise of 3.4% for CCGs in 2016/17. But this extra funding comes with strings attached.
Many community healthcare providers don’t currently have the infrastructure to support widespread changes in how and where care is delivered
There’s a strong focus on co-operation, with the most significant of the stipulations being the Sustainability and Transformation fund. This joint fund of £2.14 billion for 2016/17 will be split, with £1.8 billion devoted to sustainability and £340m going towards transformation.
Sustainability in this case will ensure that trusts are able to maintain their operational performance in the short term – in particular those trusts whose services are threatened by substantial deficits.
The transformation funding will be dedicated to helping to accelerate the pace of implementing the Five Year Forward View – not only in the existing ‘vanguard sites’, but across the country. Yet there is a danger of this section of the funding being consumed by the deficit and the progress of growth hampered.
The flexibility provided by mobile facilities can help local health economies to create the right facility environment to move from fixed sites to smaller population bases – without the need to build, build, build
The significance of the sustainability and transformation fund should not be underestimated. The stipulation for place-based planning and alignment to population need will almost certainly see a greater degree of care taking place in community and primary care settings – shifting some care and treatments currently undertaken within the acute sector.
Yet beyond the initial funding, maintaining equity of access will require a great deal of lateral thinking from CCGs and local providers. From 2017/18 and beyond the real terms element of growth in CCG allocations will be contingent upon the development and approval of sustainability and transformation plans (STP).
Several barriers may complicate the process of place-based planning for local populations. Hospitals are funded per episode of care, so trusts may well be reluctant to see those episodes of care taking place outside of acute hospitals. This is where greater co-operation between commissioners and providers will prove essential – helping to keep the focus on what best benefits patient populations rather than individual institutions.
NHS England set out its goals for a health service that is fit for our times. The NHS now needs to further develop the delivery tools and models to realise the vision
In addition, many community healthcare providers don’t currently have the infrastructure to support widespread changes in how and where care is delivered. There are plenty of surgical procedures which could easily be transferred from acute hospitals to the community setting, but without the facilities to do so this is little more than a pipedream - or would be without the advances in mobile and modular healthcare facilities over the last decade.
The flexibility provided by mobile facilities can help local health economies to create the right facility environment to move from fixed sites to smaller population bases – without the need to build, build, build.
Given that so much of future funding will be based on the effectiveness of STPs, mobile theatres, for example, will allow providers and commissioners create significant local transformation in a relatively short space of time.
In the funding allocation, we’re seeing an ambitious first steps towards the future of the NHS. The Sustainability and Transformation Fund allows and incentivises collaboration between stakeholders in local areas. When demand inevitably ebbs and flows, the pressure can be distributed more evenly across the health economy and in better alignment with the needs of the population.
As local health economies begin to draft sustainability and transformation plans over the next six months, it’s my hope that community and primary care based services will play an important piece of the puzzle of transforming local healthcare provision. To do so will require flexible capacity which is already tried and tested in the acute sector – but the potential benefit to community healthcare providers is huge.
In the Five Year Forward View, NHS England set out its goals for a health service that is fit for our times. The NHS now needs to further develop the delivery tools and models to realise the vision.
