Swindells: managers need to be “brilliant”

Fri 25 Nov 2016

MiP Conference 2016: Matthew Swindells, national director for operations and information at NHS England, told conference that NHS managers need to be “strong, resilient and brilliant” to meet the challenges posed by the Five Year Forward View

In his keynote speech to MiP conference on 23 November, Swindells said the NHS had made “spectacular” progress in the last three decades and was doing “fantastic work every day”, although he acknowledged life was particularly tough life for NHS managers at the moment.

“When I joined the NHS in the 1980s what followed was 10 years of long waits and not getting access to services. Back then 12 to 24 hour waits [in A&E] were commonplace. You would wait six months for an outpatient appointment and frequently two years for a non-urgent operation. The distance between two and a half years and four months is spectacular.”

He stressed that the challenges of making £22bn in savings, while bringing together health and social care through sustainability and transformation plans (STPs), could only be met through organisation adopting a partnership approach. “Part of our thinking and the logic behind STPs was to say we can’t do this in silos,” he said.

“We need to understand where the system breaks down at the moment. GPs will say a quarter of the patients who come to visit them do not need to see a GP. If you do a study of the people who turn up to an A&E department you get the same answer.”

A fifth of A&E attendees could be seen by a GP, he said, a fifth needed social care interventions, and another 10% could be treated through an outpatient appointment or a pharmacy visit.

Swindells also set out his concern that a quarter of hospital beds were filled by people who did not need to be there – despite the loss of independence and risk of infection that a hospital stay entails.

“And we know that two thirds of people at the end of life want to die at home with their families, yet two thirds die in hospital,’ he added.

He highlighted how the NHS sometimes failed to meet the aspirations of the people it served. He pointed out that working men are the fastest growing group of A&E attendees because they found it hard to make urgent GP appointments and then take time off work to attend them. The NHS needed to think about other ways to engage with patients, such as telephone or online consultations.

Quoting Bob Geldof about Live Aid, Swindells said STPs required egos ‘to be checked in at the door’. When the 44 STPs were formed, it brought people from health and social care together. In some cases, it was the first time they had met.

He said the focus of STPs had shifted from identifying the four or five things which could be changed to unlock the health system to setting out a business plan for delivering the Five Year Forward View.

As the STPs moved into the publication stage, further changes were needed. “We need to widen the tent out,” he said. “We need to move from senior management doing this to engaging the public. We need to widen it to a conversation with the people who are doing the work. And we need to widen it to a conversation with the voluntary sector “

But he expected the next stage of the STP “journey” to be tough, with “more noise around STPs and more difficult conversations”.

“We need to take that journey forward. We have a great NHS to protect and improve. We could choose to treat the problems we face as insurmountable… but I think our obligation is to make the changes that our necessary. The challenges for all of us are to be strong, to be resilient and to be brilliant.”

Questioned from the audience on whether commissioning support groups (CSUs) faced being “externalised”, Swindells said NHS England had been working with CSUs and “trying to bring then more into the NHS family”. He wanted to use the skills of CSU staff better and for CSUs to apply their expertise over a wider area. ‘I would like to move some of the things that my team does into CSUs,’ he added.

Swindells also played down the significance of tariff competition in the future development of the NHS, saying what was needed was the right tool to get the right experience for patients. Payment by results (PbR), for example, had been introduced when there were long waits for hospitals procedures, he said.

“I don’t think incentivising hospitals to admit more people through A&E is the brightest thing to do now,” he said. “We are not expecting PbR to be a significant part of how we plan the next two years contracting. I’m expecting to see a much more nuanced and graduated view on how we contract.”


Reporting by Alison Moore

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