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‘Stakes never higher’ for NHS

Published on 02/04/14 at 08:13am
simon Stevens image
Simon Stevens, NHS England chief executive

The new boss of NHS England has warned that he will not be able to fix its problems and said the NHS must look to other countries’ health systems for some answers.

In a robust speech chief executive Simon Stevens, who was poached from a US healthcare provider and is a former advisor to Labour prime minister Tony Blair, says: “For the NHS the stakes have never been higher. I know times are tough, and the health service is under pressure.” 

Suggesting that it was time to ‘speak frankly’, Stevens adds: “Service pressures are intensifying, and longstanding problems are not going to disappear overnight.” 

The financial year 2014-15 is going to be a ‘challenge’ and the following year ‘even more so’. “No one person can fix everything that needs fixing - certainly not me,” he admits. 

“I’ve started today listening to patients and I give you my absolute commitment that I intend to carry on doing so every day,” he says. 

“Our traditional partitioning of health services - GPs, hospital outpatients, A&E departments, community nurses, emergency mental healthcare, out of hours units, ambulance services and so on - no longer makes much sense,” Stevens goes on. 

Given the country’s ageing population, he says he would begin by attempting to find ways “of better blending health and social care for people with high needs”. 

This would involve “supporting and testing some practical new models that don’t need structural re-organisation”, he insists. “There are many current initiatives to build on, plus some international approaches that we should now try.” 

Stevens also signalled that the debate over Clinical Commissioning Groups (CCGs) should stop. “Instead let’s focus on actually making commissioning work,” he says. 

He criticises what he calls the ‘misplaced consensus’ existing within the NHS on some issues and mentions things such as “viable local hospitals that don’t all have to be huge” and ‘faster uptake of digital technologies’ as examples of things that need looking at.

He also lists the third sector’s role in health provision, the way new providers may bring innovation, putting doctors in key leadership roles, giving more professional authority to nurses and midwives and reformed pay systems. 

“What are some of the long-standing assumptions and constraints we’d need to say goodbye to?” he asks. 

Achieving change would require three things, he says: getting patients to play a greater role in their own health, supporting carers and volunteers - and “unleashing the passion and drive of the million-plus frontline NHS staff who are devoting their professional lives to caring”. 

Speaking at the International Centre For Life in Newcastle to an audience including NHS staff, Stevens said he was not naïve about the difficulties, but that ‘care is far better now’ than it was when he began working in the NHS 26 years ago. 

And although much of the speech was spent outlining the challenges, Stevens also found time to talk in more philosophical terms about the NHS, indicating the way the health service is bound up in the fabric of UK life. 

The NHS “will be there when we need it, at the most profound moments in our lives”, he said. 

“At the birth of our children,” he added. “At the deaths of our loved ones. And at every stage in between - as we grapple with hope, fear, generosity, loneliness, compassion - all the most profound elements of the human spirit.” 

Few NHS leaders have quoted John Milton over the years, but Stevens did, saying the national leadership of the NHS has to be more than the sum of its parts. 

“The alternative, to quote Milton’s Paradise Lost: ‘Thus they in mutual accusation spent/The fruitless hours…And of their vain contest appear’d no end,’” he said. “Given everything facing us, we don’t have fruitless hours to waste, and we can’t afford vain contests. 

“Said less poetically, it’s time to roll up our sleeves, pull together and get on with it,” Stevens concluded. 

Adam Hill

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