Amanda Pritchard has said integrated care boards will need to “rationalise roles [and] processes” and use “economies of scale” to cut costs, following on from NHS England’s plans to cut around 6,000 posts.
The NHSE chief executive told the King’s Fund the NHS was “efficient… in getting money to deliver most benefit for patients, with admin costs less than two pence in the pound, way below comparable countries”.
She also restated NHSE’s case that the service needs additional government funding to finance the additional costs of inflation, pay rises, and covid care.
But Ms Pritchard added: “We cannot underestimate the difficulty of the job facing government now as they look at how to raise and allocate resources.
“What the outcome is of that process, we are determined to continue our drive for efficiency… We are doing that nationally. We have already identified significant savings that can be made through the creation of the new NHSE merger, with a reduction in up to 40 per cent of our headcount.
“We will need to do that locally as well as the dust settles on the ICBs, to replace over 100 [clinical commissioning groups], rationalising roles, processes, as well as using economies of scale. We need to yield the benefits.”
Several integrated care system leaders have told HSJ they are expecting NHSE to require them to cut their overheads and staffing further.
Some CCG teams were effectively restructured and merged up to ICS level before the legal change in July this year. However, others have inherited several different local CCG teams, sometimes linked to their local “places”, and often working in different ways.
Ms Pritchard also said NHSE would identify at least one provider collaborative in every region across the country that can “show the way for others”.
She said NHSE would issue a call for submissions in the near future. The collaboratives would demonstrate how care can be improved by greater collaboration, and “harnessing” the ideas and energy of clinical leaders.
During her keynote speech, Ms Pritchard said: “We will shortly be putting a call to identify at least one provider collaborative in every region that can show the way for others, demonstrating how partnership working, underpinned by clinical leadership, can deliver better quality and better access for patients.”
Those selected will also be “leading the development of the support offer that will enable others across the country to do the same”.
Ms Pritchard indicated collaboratives may be able to spread quality improvements. She said: “For any leader in the NHS worth their salt, it [care quality] is the question most likely to keep you up at night, most likely to motivate you in the morning.
“Are our patients getting the standard of care they deserve? We know we can’t always answer ‘yes’ to that question. We know we’ve got a job to do.
“Particularly on maternity services, but not just that, inpatient services, people living with learning disabilities, with autism or with severe mental illness. We also know that in those cases, it will invariably be supporting clinical leaders that will yield the greatest improvements.”
NHS leaders have been told NHSE’s latest provider collaboratives project will seek to firm up definitions of what they are and how they should work.
Last year, each ICS was required to identify at least one collaborative in its area, but the groupings are wildly variable in what they do, and how developed they are.
Some are loose associations seeking to share back office services, for example, while others hold budgets for and commission inpatient mental health care.
Progress on provider group policy has been slow — Sir David Dalton proposed a move to more groups in a 204 report for government and there has been no firm commitment to roll this out. However, many acute trusts are now sharing CEOs and chairs, often having been pressured to do so by NHSE.
Long-term workforce plan
During a Q&A session, Ms Pritchard was asked when the NHS’s long-term workforce plan will be completed and published.
She said: “I think, at the moment, we are hopeful that will be before Christmas.
“But part of the process involves, as you would expect, wide engagement so we just want to make sure we have enough time for that as part of the process.”
HSJ understands the work is nearly complete, but the recent change in government may have set back agreement on next steps.
The work is being led by Navina Evans, NHSE’s chief workforce officer and chief executive of Health Education England, which is set to merge with NHSE in spring 2023.