Mark Stocks, the Birmingham-based head of Grant Thornton’s public sector assurance practice in the Midlands, and national lead of its health audit practice, looks at the regional healthcare economy.
The biggest element of my ‘day job’ is to carry out audits for several NHS Trusts, and for several Clinical Commissioning Groups (CCGs). As an outsider looking in to the NHS, I identify four key issues for the healthcare economy: collaboration and support, the interaction of healthcare and social care, new models of care and efficiency savings.
Governance has been a major challenge since the government closed all Strategic Health Authorities at the end of the 2012-2013 financial year. A raft of new bodies has been set up, but nobody has control of the whole system. Everyone’s had a go at setting up Sustainability and Transformation Plans (STPs), but so far, they’ve been very difficult to deliver. There’s also great uncertainty in the sector about the governance of these STPs.
In terms of collaborations, I see lots of great examples happening now - between University Hospitals Birmingham NHS Foundation Trust and Heart of England, for example - and also lots of collaborative discussions about the future, between Birmingham and Solihull CCGs, for instance.
However, as to how they will really work closer together, it’s not yet clear. Trusts and CCGs are already being pushed very hard to break even, which creates pressure on their structures and on their people.
Everyone knows that the interaction of healthcare and social care is simply not working. If you can’t keep people out of hospital by offering them support in their community, and can’t get them out when they’re ready to leave, that’s a disaster for the health service.
We can see a scenario, in the West Midlands and nationally, when councils have to make more cuts in their social care budgets because of the financial constraints they’re under, and the current problems will be magnified.
New models of care are the future, and the NHS needs to invest more in evolving and delivering them; particularly in primary care, community care and mental health. I do see a willingness to innovate among NHS Trusts here, and there are some interesting changes in primary care.
We’re also starting to see more integrated models of care, but it is patchy, and there are places that haven’t changed at all. In general, it comes back to the quality of leadership. It requires a lot of skill and thought to devise new models of care, and clear strategic analysis is vital.
In some ways, efficiency savings should be a relatively easy challenge. People know what to do - but they often don’t do it. There may be underlying reasons why trusts can’t find enough doctors or nurses, but if they don’t, they end up in a bidding war with other trusts for locums and agency staff.
We are seeing costs come down in some places, but again, it’s down to effective and timely leadership. In the worst instances, we find a doctor saying: ‘Quality, quality, quality’, but the finance director saying: ‘We haven’t got the money’.
We all see the outcomes when the trade off between quality and finance gets out of synch, but at the best places, genuine conversations are taking place about getting the balance right.
The Carter Review, in 2015, about ways of increasing productivity in Britain’s hospitals was bang-on; but the NHS can’t implement its recommendations, partly because of the lack of finance, and partly because of the lack of strategic leadership.