Simon Stevens, the Chief Executive of NHS England is not as he seems. Behind the urbane witty manner, the man who likes, apparently, to speak without visual aids, is a man of real steel. Well, Consett steel actually, as at home speaking about his early experiences of working at the then Shotley Bridge General Hospital, as defending the NHS before the Public Accounts Committee and leading five year forward views. We have two gems here, someone who knows north-east England and relishes speaking almost exclusively about public health, despite the enormity of the operational responsibilities he carries, and definitely a force to be reckoned with, as his vertical rise from junior manager to CEO, via advising the Blair government at No 10, testifies.
|Simon Stevens: a man of Consett steel|
- Re-conceptualising what we mean by the NHS – the NHS is now a pensioner, in organisational terms but is still revolving around dealing with problems as they arise, with too little spent on underlying prevention. It seems to be hard enough to co-ordinate the different services currently provided, let alone stepping up to a new level where there is no difference in health and social care, and any aspect of policy that affects life chances, and health and wellness, is integrated both in planning and delivery. But this is a goal that means a fundamental re-orientation of what’s provided, how and where.
- What about the unexploited advantages of primary care? The division between primary and secondary care in the UK, which has deep historical roots that pre-date the NHS is both a barrier, in terms of setting up a division that wouldn’t be recognised in some other countries, and also a positive, in providing personalised care, close to home. But what about the areas where primary care is all too thin on the ground, the unpopular parts of the country where GPs don’t want to work – the so-called ‘inverse care law’ which Stevens invoked. Can this be fixed through the development of a population-oriented primary care system?
- The NHS is a major buyer and employer and has a sizeable economic footprint in local communities. Back in his Consett days, the steel works had recently closed and the NHS took up some of the fall out as the local and large employer of alternative resort. This lesson has not been lost on Stevens. The NHS should be able to influence poverty and health through its own economic position in each locality.
- Work needs to be done on ensuring people get and stay in high quality jobs. The NHS can support this (partly linking back to the third point) through what it does as an employer but also could have a much stronger role in health interventions whilst people are at work. Unsaid at the time, but the workplace is somewhere people spend a lot of time, so why not? The NHS needs to set an example in being a good employer itself, but to its shame falls short, for example in the management of shift systems, or provision of healthy eating options at work. This was definitely a ‘can do better’ on the report card.
- Local Authorities have come back in from the cold with their new (or is it re-gained?) responsibilities in public health. There is an awakening to the scope local government could have, arising from the debate about devolution in England, set off by the Scottish referendum, and even within their existing powers, local authorities can reach the parts the NHS can’t reach in affecting population health and well-being.
- And finally, what about the planning of new cities and towns? These could provide a test bed for working out new ways of place-shaping and designing health and wellness into the built environment and also new ways of delivering the NHS, given the blank sheet these major developments offer.