NHSE chief executive Sir James Mackey this week (June 11) stressed that commissioners must focus on “outcomes and results rather than inputs” as part of the hotly anticipated 10-year health plan.
He told delegates at the NHS Confed Expo in Manchester that “every time” an NHS chief executive rehashes old service and spending plans, he is “breaking it”.
“We’ll go back and say ‘that’s not what we’re doing now, we’re focusing on outcomes’”.
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New NHSE chair Dr Penny Dash doubled down on the message during the conference’s welcome speech, saying that integrated care boards (ICBs) must only commission “things that have impact and improve outcomes”.
They must also ensure “that we can we commission them at the right cost – that means what things should cost if we are working efficiently and effectively, not what things do cost”, she stressed.
But ICB leaders have revealed that justifying community spending may prove difficult.
“Better understanding”
During a panel on commissioning on the same day, Black Country ICB chair Anu Singh said that the “one thing” she wants from providers like pharmacies, GPs and NHS trusts is “better understanding”.
“The one thing that matters…[is] our improved outcomes,” she added.
“At the moment, even with the best relationship sometimes there’s a lack of real understanding around that joint endeavour,” she said.
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But NHS Kent and Medway ICB chief strategy and partnerships officer Ed Waller warned that “there is something about our understanding of how we spend our money in a community that we have not managed to solve”.
“We’ve solved it in the acute sector because of the way we designed payment systems and data flows,” he said.
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“But until we understand…a little bit more about how we spend our money, what it costs us to do things [and] what outcome some of the things we pay for deliver, it will be much harder to empirically prove how to spend money well in the community,” he added.
“That is a bit of a barrier,” he said.
“For me as a commissioner, trying to get to the bottom of some of those questions will be a key part of making the case to move money into community care,” he added.
ICB latest
In March, Prime Minister Keir Starmer made the momentous announcement that the Department of Health and Social Care (DH) is set to absorb NHSE over a two-year period.
At the time, NHSE chief financial officer and deputy chief executive Julian Kelly confirmed that as part of the move ICBs must cut headcounts by 50% – leaving some 12,500 ICB staff at risk of losing their jobs.
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When questioned on ICB cuts at a Medical Journalists’ Association (MJA) event last month, Mackey admitted that while he “still really wants this to be enacted in this financial year…none of this is nailed down to the point where it’s a completely fixed commitment”.
But he stressed that job cuts must be “done” by “the end of quarter three” in December.
