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NHS leaders see slow progress towards new models of care

NHS organisations must tackle cultural barriers and create robust integrated care services to realise the aspirations set out by NHS England’s Five Year Forward View (FYFV) and NHS Scotland’s 2020 Vision, according to a new study by Grant Thornton UK LLP.

Almost 18 months after the implementation of the NHS Five Year Forward View (FYFV), the study found that three out of five NHS leaders believed that it has had little or no impact. Those interviewed for the study (see methodology below) mainly attributed this slow progress to cultural differences between key partners. 

The study sets out recommendations for NHS organisations to improve their governance arrangements. For example, it suggests that by investing in staff and empowering them to deliver new models of care, NHS organisations can drive greater integration, helping them respond to the growing pressures on health and social care services. 

Forty-six percent of survey respondents do not believe their local health economy has a shared strategy and plan to implement the FYFV’s key aspirations. Moreover, three out of five perceive little or no impact from their local health economy. 

In addition, 59% of trusts did not deliver their 2014/15 cost improvement programme, compared to 48% in 2013/14. 42% of respondents believe their organisation will probably post a deficit by 2020. A further 32% feel it is reasonably possible. These figures emerge less than a week after the Budget, which saw no additional investment in the NHS. 

Mark Stocks, Partner from Public Sector Assurance at Grant Thornton, said: 

“As the NHS moves towards new models of care, organisations are considering how they can deliver high quality, innovative and integrated services under a risk-aware patient-led culture. However, our study shows that the pace of change in many a number of health economies is painfully slow. Many NHS leaders have witnessed resistance to significant and sustainable change due to the unique and cherished nature of the NHS. 

“Our research shows that changing the culture of health and social care needs to be a planned and iterative process. It requires local health economy partners to unlock formal and informal cultural values and behaviours and to find commonality on health and social care outcomes. 

“By engaging with and empowering people, NHS organisations can harness people’s creativity and professionalism towards making new models of care work. The NHS must improve its focus on better demand management; greater integration of health and social care; more pooled resource directed at preventative public health initiatives; increased co-operation between NHS providers; reduced agency costs through better workforce management; and smarter procurement decisions. 

“Of course, NHS organisations are operating under difficult financial circumstances. The NHS in England overspent for the first time as a complete sector in 2014/15: the £182 million net surplus generated by CCGs could not outweigh the £843 million total net deficit recorded by providers. This bleak picture is compounded by the fact that almost three in four respondents in our survey believe their organisation could be in deficit by 2020. Rigorous financial governance at non-executive director and officer level is critical to halt the growing financial sustainability pressures. 

“For many NHS organisations, the introduction of Sustainability and Transformation Plans will allow them to focus on the importance of cultural change. At the centre of this, clear leadership and investment will be needed to turn the aspirations for the NHS into reality.” 

Grant Thornton is committed to supporting a vibrant economy. Sustainable and successful public services are a vital component of a vibrant economy. Grant Thornton believes that the current public sector reforms present real opportunities to redesign and integrate service delivery, with the public at its heart. The firm is passionate about supporting cross-sector solutions to health and social care challenges and developing its business to advance this important agenda.