{"id":32303,"date":"2014-09-12T14:08:51","date_gmt":"2014-09-12T13:08:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32303"},"modified":"2014-09-12T14:08:51","modified_gmt":"2014-09-12T13:08:51","slug":"richard-smith-simon-stevens-chief-executive-of-nhs-england-live","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/09\/12\/richard-smith-simon-stevens-chief-executive-of-nhs-england-live\/","title":{"rendered":"Richard Smith: Simon Stevens, chief executive of NHS England, live"},"content":{"rendered":"

\"richard_smith_2014\"<\/a>When Simon Stevens, chief executive of NHS England, was buying his Sunday papers a few weeks ago he encountered an elderly woman complaining that her newspaper didn\u2019t contain the television section. It did, as the newsagent pointed out to her before asking her, \u201cWould you like me to walk you home?\u201d Stevens was struck that this was a \u201cdementia friendly community\u201d in action. He followed the story by emphasising that the traditional \u201cfactory model of health and social care\u201d will not solve society\u2019s problems, including the rise in dementia. Without a redesign of health and social care services, the NHS will not be sustainable. \u201cWe don\u2019t exclusively own the problem or the solution,\u201d he said.<\/p>\n

As he spoke on Tuesday night to a packed room of mostly senior people from every part of the health sector, Stevens stood with nothing between him and the audience, spoke without notes or a PowerPoint presentation, started by telling stories, spent most of his time answering questions, joked easily, used everybody\u2019s first name, got some of those in the audience to answer the questions, evaded some questions so cleverly that even the questioner didn\u2019t notice, and played the audience as skilfully as any top flight stand up comedian.<\/p>\n

The meeting was the tenth anniversary of the Cambridge Health Network<\/a>, which brings together people from across health\u2014the NHS, government, charities, universities, the private sector, and social care. Stevens spoke at the first meeting of the network, back when he was health adviser at No 10 to former prime minister Tony Blair.<\/p>\n

Stevens\u2019s first story was about how he spent a recent Friday night with a GP out of hours service in the east end of London. There he saw the extreme pressure on frontline services, but also saw how we have created a \u201cchaotic, complex, Heath Robinson service\u201d of 999 calls, 111 calls, urgent care centres, A&Es, and the like that cause \u201cmass confusion.\u201d The answer can\u2019t be more and faster, but must be redesign.<\/p>\n

Stevens also recently spent an afternoon chatting to people with learning disabilities. We may think, he said, that we have modern, responsive services, but he heard \u201cshocking stories\u201d from the people. He concluded that people with learning disabilities lack power and that too many services lack \u201cmoral legitimacy.\u201d<\/p>\n

The need for transformation<\/strong><\/p>\n

The need for transformation\u2014not doing it more but doing it differently\u2014was one of the themes of the evening. The NHS in England is going to have to become something different to survive as a service that covers everybody, that is free at the point of care, and that offers equal quality care for all. Redesign is not another administrative reorganisation, most of which were “displacement activity.\u201d<\/p>\n

What about the workforce, particularly nurses? Stevens was gently tough on this one. He regretted that Agenda for Change had not led to the workforce redesign that was hoped for a decade ago, and said that while more nurses in hospitals might be a good thing, it shouldn\u2019t be at the expense of nurses in the community or other needed staff.<\/p>\n

The NHS will be pursuing three timelines over the next six months, said Stevens. Firstly, during the winter it must maintain the performance the public expects, and not let A&E or surgical waiting times get out of control. Secondly, it must be sure to get itself into position to be able manage the financial year of 2015\/16. Thirdly, the NHS will publish a “forward view” that lays out strategic choices for the next five years. Some of the choices will build on the advantages of the NHS, but others will tackle \u201cblind spots,\u201d such as\u00a0neglecting the role of the employer and the workplace to promote health. And the NHS itself, he observed in passing, needs to do far better in promoting the health of its own staff. The usual thing, he added, is for the first of these activities to crowd out the second, which in turn crowds out the third, but that can\u2019t happen now.<\/p>\n

Has commissioning worked, and will it work?<\/strong><\/p>\n

We\u2019ve had commissioning for 10 years in England. Has it worked? Might it work better in the future? In fact, it\u2019s been going not for 10 years but for 23, pointed out Stevens\u2014somebody who expects his managers to \u201cknow their numbers.\u201d He accepted that it hadn\u2019t achieved enough, but he has high hopes. He referred to a poll of clinical commissioning groups in the Health Service Journal,<\/em> showing that most CCGs are being bold in their thinking. Come back in 10 years\u2019 time, he told the questioner, and we will \u201cblow your socks off\u201d with what we\u2019ve achieved through commissioning.<\/p>\n

Stevens wants integrated personal health and social care budgets. They potentially have the ability\u00a0both to shift the power relationship\u2014empowering those patients with the biggest problems\u2014and to reshape services more effectively than a top down redesign. Asked about potential problems, he said that the devil would be in the detail, and that he was more interested in achieving depth rather than breadth in the next year or two. Local government, which is much more financially constrained than the NHS, would, however, like to go much faster, seeing the budgets as a way to shift resources from health to social care.<\/p>\n

Being a leader<\/strong><\/p>\n

Leaders, I strongly believe, must put themselves in front of the people they lead, particularly when times are hard, and they must get to every part of the organisation they lead. Stevens has been out in the NHS\u2014often in the most unglamorous parts\u2014constantly since he started in April, and he was very comfortable in front of the potentially tough audience of the Cambridge Health Network.<\/p>\n

But leaders must also be ready for anything, and he described at the start of his speech how he\u2019d just been on the BBC Jeremy Vine radio show, expecting to be asked about closing the \u00a330bn gap in NHS finances and responding to Mid Staffs. Instead, the first question was, \u201cWhat was your relationship with your mother like?” Stevens readily confessed that this was a far harder question to answer on air. It\u2019s encouraging that\u00a0the leader of the NHS’s mother will keep him right.<\/p>\n

Richard Smith<\/strong>\u00a0was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.<\/em><\/p>\n

Competing interest: RS has known Simon Stevens for 20 years, and worked with him and for him at UnitedHealth. Staff from UnitedHealth cannot have any work related dealings with Stevens for a year. RS is still employed by UnitedHealth, but has no responsibility for what happens in Britain. He works with centres in low and middle income countries.<\/p>\n","protected":false},"excerpt":{"rendered":"

When Simon Stevens, chief executive of NHS England, was buying his Sunday papers a few weeks ago he encountered an elderly woman complaining that her newspaper didn\u2019t contain the television […]<\/p>\n

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