Smith Square Briefing – Nanny’s Back

23 October 2014, Blog

Nanny’s back

Today saw the release of the much anticipated Stevens review of the National Health Service. After a period in the United States Simon Stevens, head of NHS England, returned to the UK to look at the NHS’s balance book and strategy to combat the country’s demographic challenges. His return, and report, has had an almost messianic degree of anticipation.

The fact that his report has come after the main political parties, think-tanks and health bodies have laid out their own visions makes it all the more important. The question/debate will now be who, how and when people react to his recommendations – the spotlight clearly being most focussed on Labour and the Conservatives.

Today in Parliament Andy Burnham asked how Jeremy Hunt was planning to pay for the report’s recommendations, while Mr Hunt highlighted it was “no endorsement” of Labour’s plans either and that they should focus on “where they agree.”

The former Labour councillor, and adviser to two Secretaries of State, has released (by health service standards) a relatively short report at 39 pages. But what is perhaps most interesting is its tone. Public debates around the health service have been near apocalyptic in tenor – the Five Year Forward View is both positive in outlook and praiseworthy of the progress already made.

That said, as you would expect, it identifies some serious challenges to the health service, challenges that it urges our leaders to be brave in facing. The report has 16 key points but it is not until point 7 where you start to see where Mr Stevens is going.

For him the NHS’s future is one that “dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment.” When you read on it becomes clear that he’s not kidding.

New suggested structures include Primary and Acute Care Systems (essentially merged GP and hospital services) and a comprehensive redesign of urgent care services where he proposes integrated A&E departments combined with out-of-hours GPs and 111 advice. Outside of hospitals he suggests Multispecialty Community Providers (a sort of one-stop-shop for outpatients with mental, physical and social care requirements). It all makes for a potentially radically different health picture.

Read outside the bits the report has bolded for you and the document speaks to a more interventionist health service. Nanny will now come to you it would seem; Mr Stevens majors on the public health dialogue at the start of his report and has certainly focussed on it in his various interviews today.

Smoking/alcohol strategies and the end of a “one size fits all” health service need to be designed to work around our increasingly expanding waistlines. The “sicker population” of England (as his report is not a nationwide look) needs more help to lead healthier lives, Mr Stevens seems to suggest.

How much is this going to cost? Well more than we’re already paying – £8 billion more a year to be precise(ish). The report is direct in its support of the efficiency savings already made, and the huge steps taken by the existing NHS workforce. But when 70% of the health budget is spent on long-term conditions, the report is clear that “radical” change needs to happen, and now.

After years of let “a thousand flowers bloom,” Mr Stevens is calling on the national leadership to “choose from amongst a small number of radical new care delivery options.” It’s decision time.

The doctor will see you now

At the heart of Simon Stevens’ reform plans are four key pillars:

  • The Public Health agenda – Firstly, it argues we need to do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The Forward View backs hard-hitting action on obesity, alcohol and other major health risks.
  • Choice – Secondly, it commits to giving patients more control of their own care, including the option of combining health and social care, and new support for carers and volunteers.
  • The long-term – Thirdly, it says the NHS must change to meet the needs of a population that lives longer, for the millions of people with long-term conditions. This means breaking down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care. The Five Year Forward View sets out new models of care built around the needs of patients rather than historical or professional divides.
  • Flexible federalism – Fourthly, it sets out the actions we will need to take in order to develop and deliver the new models of care, including greater alignment between the national NHS bodies to provide meaningful local flexibility in the way that payment, rules and regulatory requirements are applied. It proposes more investment in our workforce, technology and innovation.

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