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Simon Stevens call for bold action to make NHS fit for the future

Simon Stevens speakingNHS England Chief Executive Simon Stevens today called for bold action on prevention, the redesign of care and efficiency to help the NHS through the most challenging period in its history.

In his first speech since the general election – and sharing a platform with the Prime Minister – Mr Stevens said:

“We’ve just come out of a general election debate that has once again confirmed a fundamental consensus between citizens of this country – on the unique importance of the NHS to the life of our nation, and as the embodiment of the promises we make to each other, across the generations.”

Referring to the NHS Five Year Forward View, he says: “Last Autumn the Health Service came together to chart a shared direction for our country’s NHS.

“Patients groups, caring professionals, national leaders – uniting behind the NHS’ own ‘manifesto’ for the next five years. It’s a plan for better health, more personalised care, and a financially sustainable Health Service, which we’re now getting going on.”

Pointing to the realities of current service pressures, he argues that the Health Service is entering probably the most challenging period in its 67 year history. Alongside action this year to stabilise NHS finances, Stevens argues for a new partnership between the public, the government and the health service, involving concrete and sometimes controversial action on three broad fronts – prevention, care redesign, and efficiency linked to new investment.

On prevention, while life expectancy is at its highest ever, smoking still explains half of the inequality in life expectancy between rich and poor, binge drinking costs at least £5 billion a year, and junk food, sugary fizzy drinks and couch potato lifestyles are normalising obesity. So we need wide ranging action – as families, as the health service, as government, as industry, using the full range of tools at our disposal.

On care, Stevens argues the mission-critical task over the next five years is fundamental redesign of how services are provided, blurring the old boundaries between GP and hospital care, physical and mental health services, health and social care. One of the best ways of getting this personalisation and integration will be to give patients and their families more clout over the support they receive. He points to the first wave of 29 ‘Vanguard’ areas across England, covering five million patients, launched six weeks ago.

On efficiency, Stevens notes that the Economist Intelligence Unit has shown that we already have a lean and efficient health service compared with just about every other industrialised country.  But we still have big quality and efficiency differences – between different parts of the country, between different hospitals, and between different local clinical commissioning groups.

On funding, Stevens says: “Just like every health service around the world with a growing population and an aging population, we’re going to need more funding, year by year, not just in 2020.

“We’ve said at least £8 billion a year in real terms by the end of the decade. But precisely how much, and with what phasing, will partly depend on how radical and how successful we are on prevention, on care redesign, and on our broader efficiency programme. And we’ll need careful and disciplined phasing of our ambition to expand services – be it improved cancer care, mental health, primary care, seven day services – all of which we want to do.”

See Simon’s full speech below.


“The Next Five Years for the NHS” – Simon Stevens, Chief Executive NHS England

West Midlands, 18 May 2015

Last Autumn the Health Service came together to chart a shared direction for our country’s NHS. Patients groups, caring professionals, national leaders – uniting behind the NHS’ own ‘manifesto’ for the next five years.

It’s a plan for better health, more personalised care, and a financially sustainable Health Service. An NHS which at all times ‘thinks like a patient, and acts like a taxpayer’.

And now we’ve just come out of a general election debate that has once again confirmed a fundamental consensus between citizens of this country. On the unique importance of the NHS to the life of our nation. And as the embodiment of the promises we make to each other, across the generations.

So we have a plan, and we have backing for it. Founded on national pride in what the NHS represents. Tempered by the reality of current pressures on services. Propelled by an optimism that amazing medical advances lie within reach.

But to succeed over the coming five years we’re going to need a new partnership between the public, the government and the health service. So today here in the West Midlands let’s be clear about what this’ll take.

It means concrete, comprehensive, and sometimes controversial action on three broad fronts.

Prevention

First, as a nation it’s time to get our act together on prevention.

Yes, life expectancy is its highest ever. But smoking still explains half the inequality in life expectancy between rich and poor – and two thirds of smokers get hooked as kids. Binge drinking costs at least £5 billion a year – in A&E admissions, road accidents, extra policing. Junk food, sugary fizzy drinks and couch potato lifestyles are normalising obesity – and as parents, a third of us can’t now spot when our own child is seriously overweight.

So we’ve got a choice. Condemn our children to a rising tide of avoidable diabetes, cardiovascular disease, cancer? And burden taxpayers with an NHS bill far exceeding an extra £8 billion by 2020? Or take wide ranging action – as families, as the health service, as government, as industry. Using the full range of tools at our disposal.

It’s a no brainer – pull out all the stops on prevention, or face the music.

Care

But when people do actually need looking after – as millions will – our families deserve care that’s more personal, more coordinated, more convenient, safe and reliable.

So the second of our mission-critical tasks over the next five years is fundamental redesign of how services are provided. Blurring the old boundaries between GP and hospital care,

physical and mental health services, health and social care. Because for the young man with cancer, it’s the multidisciplinary team that counts – the GP, cancer nurse, the surgeon, the oncologist, and radiotherapist, all working together. For the new mum with postnatal depression, physical and mental wellbeing combine. For the grandfather with dementia, social support and community nursing need to blend together, not battle it out.

And one of the best ways of getting this personalisation and integration will be to give patients and their families more clout over the support they receive. If the NHS is a cradle to grave service, let’s give pregnant mums real choices about safe birthing options. Let’s ensure that people who die in hospital can do so at home if they prefer. And that for the parent whose child becomes sick on a Sunday, we’ve a more integrated seven day service, ending confusion about whether to call the GP, or 111 or 999, or go to A&E.

Six weeks ago we got going on redesigning care in 29 areas across England, covering five million patients. This morning I took the Prime Minister to see what it means here in the West Midlands.

Easier appointments for patients. Convenient alternatives to A&E. Even the option to skype your doctor direct from your mobile phone. Not pie in the sky. Happening right here, right now. Supported by more investment in primary care, closer working with hospital specialists, joined up care with the council. Also not pie in the sky. Happening right here, right now. And later this week I’ll be announcing the broadening of this work to include hospitals across England.

Sustainability

So prevention and care redesign – over time they’ll both help with our third major challenge which is putting the NHS’ finances on a sustainable footing. But they’re not a quick fix, and they won’t be enough.

As the Economist Intelligence Unit pointed out a few days ago, we already have an incredibly lean and efficient health service compared with just about every other industrialised country.

But – and it’s a multi-billion pound ‘but’ – we still have big quality and efficiency differences – between different parts of the country, between different hospitals, and between different local clinical commissioning groups. We have unused land and buildings. We have inefficient procurement practices. We can work better with the voluntary sector, with local government, and with other employers. And as the largest employer in Europe the NHS itself can still do better at training and employing our skilled and dedicated frontline staff – including immediate action to convert agency staffing into permanent nursing jobs. So in a fortnight’s time my colleagues and I will be spelling out how the NHS will be mobilising to tackle this, our so-called £22 billion efficiency challenge.

Even then – just like every health service around the world – with a growing population and an aging population we’re going to need more funding, year by year, not just in 2020.

We’ve said at least £8 billion a year in real terms by the end of the decade. But precisely how much, and with what phasing, will partly depend on how radical and how successful we are on prevention, on care redesign, and on our broader efficiency programme. And we’ll need careful and disciplined phasing of our ambition to expand services – be it improved cancer care, mental health, primary care, seven day services – all of which we want to do.

None of this will be easy. In fact the Health Service is entering probably the most challenging period in its 67 year history.

We’ll certainly step up and play our part – but the NHS can’t do it alone. Because the NHS isn’t just a care and repair service, it’s a social movement. We’re going to need active support from patients, the public, and politicians of all parties. Support that we’re optimistic about getting.

Because there’s no nobler ambition, no higher calling, than advancing the health and supporting the wellbeing of all families, and all communities, across the length and breadth of this country.

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6 comments

  1. Herbert Brown says:

    For goodness sake get a grip of the N H S before it’s too late these practises have been going on for years the papers have been full of stories about agency cost for years and nothing has been changed get yourself a team of German people they don’t pussie foot about like us even if it effends some people but get results then you will be forgiven Thank You Herbert Brown

  2. martin says:

    @NHSEngland An interesting interview between Simon Stevens and Andrew Marr this morning on the BBC political programme. If the NHS wants to stop using temporary staffing services, then permanent and loyal staff need to be stop being threatened with having their unsocial hours pay cut, or hard earned increments removed. Retaining staff is the key, if you take away what little they have already, more staff will leave, and recruitment will become increasingly more difficult. Its not just a vocational job its a livelihood, and a career that requires hard work ongoing training and commitment. If you lose that commitment due to low morale and motivation amongst permanent staff you lose the good and highly skilled nurses you already have.

  3. Anonymous says:

    It appears to me to be common sense to go to 7day/week service, and particiularly for emergency and urgent care. Health care should reflects today’s medical advances and the populations needs. To achieve this will be a real challenge not least the importance of remembering that the health of health care staff must be looked after, if we are to have a chance, with a common sense approach i.e greater choice of healthy food options in hospital and health care providers; ensuriung breaks area taken, staff having a quite area to have that break, real committment to supprot work life balance, encourangment that health workers have a healthy life style and weight to act as role models, staff are paid for overtime required (which should not be frequent), bullying is not tolerated.

  4. It is a good speech and makes the priorities clear. Prevention is critical, though it’s not a medical and largely not an NHS matter, it’s about public health and wider policy on smoking, food, education, transport, and especially inequality.
    The issue for the NHS is efficiency: we have arguable the world’s best system design, we just need to make it work much better to deliver what it needs to against the capacity and demand pressures it inevitably faces.

  5. As a hospital doctor I find the vision inspiring and admirable. The practical implementation will be the challenge. How about one step at a time; a 6-day-week NHS first?

  6. Steve Edmunds says:

    However laudable to aims, I just cant see how this can be delivered. There is no attempt by anyone at demand management to match resources available. Also no clarity if 7day working means full NHS services or just emergency care.
    If full services resources will be stretched too thin. If emergency care then we need demand management to help people access services appropriately.
    I am a GP. On call in the last month, I have had two anxious patients phone up from the outpatients car parks to convey to me the next referral and tests as advised by the specialist and said to be passed back to me to action. They were not prepared to wait till I get a letter, so I either risked a complaint at the delay in postponing an onward referral or refer again in a game of medical Chinese whisper.
    The idea that I will be Skyped from patient mobiles and be available 24h/d to emails suggests that I am not already flat out 11h/day. Added new methods of being ‘available’ and stretching into another 2d/week quite simply means that when I turn 60 (8m and counting) I shall either leave altogether or drastically reduce patient contact to a level that I judge safe, sane and sustainable.