THERE’S a new boss at the NHS. Today, Simon Stevens takes up the reins as chief executive of NHS England, the quango now responsible for the vast majority of the health service’s £100bn budget. Back in October, many welcomed his appointment to the top job in the NHS. After working for Tony Blair and Alan Milburn, when he was the principal architect of the then government’s reforms, Stevens landed a position at the leading US health firm UnitedHealth. If the NHS is our national religion, a lot of faith has been put in its new prince from across the pond. However, as well as being a new dawn for the NHS, there is a bad moon rising.
In recent weeks, many in the NHS have woken up to the size of the mountain it has to climb to ensure quality care for all. Even though the government chose to ring-fence the NHS budget, demographic costs and rising patient expectations mean the NHS cannot be protected from the need to change. Little progress has been made on improving productivity or reforming services, and many have started to warn that the system is about to hit the financial buffers. With half of all NHS hospitals sliding into deficit, NHS England’s outgoing chief executive Sir David Nicholson called on the Treasury to find a £2bn bailout for the health service. However, that would be no substitute for the kind of change that Stevens will have to deliver.
Stevens also inherits a system that is still implementing reforms that, in the words of his predecessor, were so vast they “can be seen from space”. As a result, many of the NHS’s innovators have become trapped in a labyrinth of new regulations and bureaucracies. Stevens will need to begin unravelling the complications and tensions that continue to frustrate those on the front line. But as well as being a skilled and patient administrator as he picks his way through the NHS’s organisational shanty town, the new chief executive will need to champion a vision for change. After sleepwalking into a crisis, the NHS needs a strategy for survival.
Radical restructuring of England’s hospital estate should be top of the list. As healthcare needs have changed, the traditional local hospital has fallen behind the times. Rather than trying to provide every service to patients under one roof, hospitals need to specialise in solving just one problem if they are to ensure the highest standard of care. In London, for example, stroke care has been moved from 34 hospital sites to eight dedicated 24/7 units. But more of this will have to happen, alongside a massive shift of resources out of hospital wards and into community services.
Next on the agenda will be opening the doors of the NHS to new entrants in order to turbo-boost innovation and productivity. In the last few years, government ministers have been reticent about advocating competition in healthcare, and spending on non-NHS providers has begun to decline. While the health secretary has hailed a “technology revolution” in healthcare, this will only be achieved in practice by allowing disruptive new providers to enter the market and fundamentally transform the way we deliver care. Doctors at the Mayo Clinic in America, for example, have worked with Apple to develop an app which allows patients to book appointments and access their health records through their phone. Too little similar innovation takes place in the NHS today.
Finally, the NHS needs to get to grips with managing demand. While hospitals continue to face a surge of patients turning up at A&E, not enough has been done to help them to use alternatives. Engaging patients in their care will help consumers make better choices, enabling them to manage their own health more effectively. There are many eye-catching ideas as to how this can be achieved, including the introduction of a monthly NHS membership fee, as proposed by Lord Warner’s recent Reform report.
As the general election approaches, another NHS reform drive might win Stevens few friends in Westminster. Yet those who will make the case for change can take comfort from what has already been achieved in the NHS and overseas. As the Harvard business guru Michael Porter set out at a Reform conference in January, organising care properly can improve outcomes and deliver savings of up to 40 per cent. Political parties cannot afford to shy away from the challenges facing the NHS, and the tough choices that lay ahead.
Thomas Cawston is research director at the independent think tank Reform. Its latest NHS report Solving the NHS cash and care crisis is available at www.reform.co.uk