By David Talbot, Consultant, London
Appearing before the new House of Commons Health Select Committee on Tuesday morning, Simon Stevens, Chief Executive of NHS England, took part, along with Sir Bruce Keogh and Jane Cummings, medical director and nursing director respectively, in a marathon three hour session. Topics ranged from general practitioner recruitment and weekend working through to comparing the complexity of managing the NHS being greater than that of selling underwear – in reference to Sir Stuart Rose, former Chief Executive of Marks & Spencer’s, long awaited review of NHS leadership.
The triumvirate came before the Committee at a critical time for the NHS. Last October, NHS England published the Five Year Forward View, the first time the NHS itself had published recommendations on its own future. Such a decision underlies the seriousness of the situation facing the health service, indeed the basics, as underlined by Stevens, is that the NHS needs to save £22bn by 2020, alongside an £8bn annual funding increase from Government, merely to remain sustainable.
The NHS England chief told MPs that the “single most important thing” this year for the NHS is to reduce agency spend. Converting temporary staff into permanent is the NHS’s “biggest operational financial risk” Stevens, then backed up by Cummings, told the Committee, that hundreds of millions of pounds spent on agency staff would have to be taken out of the NHS budget this year.
In earlier questioning there had been some scepticism from MPs, particularly from Labour MP Emily Thornberry, about whether the NHS can make the identified £22bn of savings over the Parliament. Stevens explained where he thought these savings would be made; a quarter would come from “prevention and demand moderation”; another quarter would be achieved by reducing the prices charged to the NHS, while the third, about fifty per cent, would be from the “voluminous” productivity opportunities in the provider sector.
The session also touched upon the topic of a ‘seven day NHS’, as prescribed by Jeremy Hunt, the Health Secretary. Hunt had courted controversy last week with a speech claiming a “Monday to Friday culture” in the NHS which, he said, was leading to six thousand preventable deaths. This has led to the #ImInWorkJeremy social media campaign by NHS professionals highlighting their work over last weekend. But Sir Bruce told the Committee “there was pretty clear evidence of a weekend effect” starting on Friday and carrying on into Monday which was leading to higher mortality. He said there was a 2 per cent rise in mortality for patients admitted on a Friday, and a 5 per cent increase for those admitted on a Monday. NHS England is to shortly publish research to confirm this trend.
Stevens opened the session by answering the question from the Chair, Dr Sarah Wollaston MP, on what kept him awake at night; he explained that his main priorities were keeping current services running while establishing “how to manage for today while transforming for tomorrow”; getting the balance right between local energy and national accountability and thirdly, “juxtaposing our focus on the national health service” whilst linking it to other government departments. No small tasks then for the Parliament ahead.