I have heard Simon Stevens speak, and read the Five Year Forward View.  His utterances and writings are very intense, and have to be thought carefully about.

First let us dismiss the canard that because he worked for United Health in America he is automatically bon a mission to privatise the NHS.  In fact he worked for the part which dealt with Medicare, a state-funded scheme.

I think his ideas have merit and the SHA should consider them. (Bear in mind of course that he did not write the Five Year Plan single-handed.  It is the result of much debate in the NHS.  I have been aware of this.)  The SHA may not agree with all he says, but I think we should endorse some of his ideas.  In particular I note the following points which he makes in the HSJ lecture:

  • He points out the “perverse incentives” in the NHS, whereas hospitals have incentives to acquire more patients, whereas CCGs are trying to stop people going to hospital when they can.
  • He notes the importance of local initiatives, and stresses collaboration between different agencies. He wants flexibility.
  • He also comments on the “two axes” (not about cuts!) of increased scale for some specialist surgery, whereas better technology and “miniaturisation” (first noted by Willmott and Young) will enable more to be done locally, and could benefit smaller hospitals. Much of the debate is about reorganisation of services, and the fact that not all hospitals can do everything.  Perhaps we should think instead about what smaller locally based provision can do.
  • There is an overall thread of collaboration and integration, between primary and specialist services, physical and mental health, and health and social care. Later he talks of “Multispeciality Providers”, and in true NHS manner, invents an Acronym.

None of this is about public or private provision, and seems to stress collaboration which the SHA should favour.

The funding mechanisms may prevent this, and I would think Trusts will have to cease being independent and enter into some sort of agreement with local authorities and CCGs.  At the moment we have money going to the Better Care Fund, and Trusts blithely ignoring this, assuming that the government will bale them out.

All this probably makes sense to us, but we then have the sort of attack on successful local authority/NHS collaboration as reported in the Guardian on Tuesday under “Top Tory wants bigger role for private firms in NHS”.  (That headline doesn’t exactly win a prize for originality. Perhaps they should have added that Queen Anne was dead too.)

It is about Frances Maude’s thoughts about the Better Care Fund.  He comments “ I think the disappointment about the Better Care Fund has been how public-sector a lot of these solutions proposed have  been, and it would have been, I think, better if we had seen coming out of it more ideas for different groups forming themselves together”. He then extolled how Inclusion Healthcare was both cheaper and more efficient, on the basis of one example.

Even when the public sector responds to a challenge you cannot win with this lot.  Our task, I think is to convince the electorate that the public sector can be flexible, innovative , and cooperate between silos, if we are to meet the challenges ahead.

(Advert:  I have thought about these ideas further in my book “Reclaiming the Big Society”)

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  1. 26 December 2014
    Dear Socialist Health,
    Your aside re Queen Anne being dead, set me wondering about the nation’s health system in times past.
    What precisely were the health systems in place which the NHS replaced when Labour introduced the National Health Service after the end of the Second World War? And what was on offer in the brand new NHS at its inception? How much of the current NHS is

    a] the same as the original NHS, and which parts, if any?
    b] different from the original NHS, and which parts, as clearly there have been major changes?
    c] what is the future of the NHS?

    These seem to be the planks of the NHS debate and what is to determine its fate.

    As to the concept of private care within the NHS, in reality it has always been there in essence on account of the fact that doctors who were in private practice did not cease to be able to do private practice as well as do NHS work.

    This then seems to be coming round full circle so that there is decentralisation and moves to local control, but then there may end up being greater inequalities of health and social care in consequence.

    If one lives in a poor and impoverished environment, you may find yourself being lucky to live 20 years less than a person in a wealthy environment.

    This is what needs to be considered. Do we try and maximise health outcomes for everyone?

    The founders of the NHS had no doubts in their minds that they were getting a good outcome for all.

    Let us hope that the NHS can survive and can give optimal treatment to all and any that need it in the appropriate timeframe and not have queues outside a GP’s surgery as shown in a photograph in the national press only days ago.

    Thank you for raising the debate.

    Rosemary Cantwell

  2. geoffbarr says:

    My feeling about Steven’s grand plan was that it was heavy on fantasy. As the system is driven into crisis we lift our heads and dream of a better tomorrow. Meanwhile real life continues.

    Most of the various sub-units of the NHS need more money than they are allowed and the government is desperate to ensure that massive failure does not break out somewhere.

    Good ideas about integration of mental and physical health services and the money other useful plans are premised on a stable plannable system and the government has moved further down the road of wrecking that.

    So dream on.

  3. Just in case we lose sight of whom we are actually talking about I thought it would be useful to look at his background:

    From 1988 to 1997 he worked as healthcare manager in UK and internationally. He started his NHS professional career with a week’s work experience as a hospital porter and doing paperwork in a mortuary in Durham. Later, he moved on to be general manager for mental health services at North Tyneside and Northumberland and later group manager of Guys and St Thomas’ hospitals in London.[4] In 1997 he was appointed Policy Adviser to two Secretaries of State for Health (Frank Dobson and Alan Milburn) and from 2001-4 was health policy adviser to Tony Blair. He was closely associated with the development of the NHS Plan 2000.

    From 2004-6 he was President of UnitedHealth Europe and moved on to be Chief Executive Officer of UnitedHealthcare Medicare & Retirement and then President, Global Health, & UnitedHealth Group Executive Vice President of UnitedHealth Group. In October 2013, the speaker biography of Stevens for a health networking conference read, “His responsibilities include leading UnitedHealth’s strategy for, and engagement with, national health reform, ensuring its businesses are positioned for changes in the market and regulatory environment.”[5]

    While in the USA, living in Minnesota, he continued to write articles about the NHS.

    Someone who came through the Labour movement to end up working for an American Private Health Company certainly doesn’t give me the confidence that he has the NHS and countries interests at heart.

    The truth of course is that this is a totally sterile debate, the concentration is of the supposed shortage of funding within the public services as a whole, the debate has therefore been about the shrinking of service provision and not about delivering what NYE BEVAN envisaged, which has proved to the most successful provider the world has ever seen.

    The NHS along with all the rest of the public services has been strangled to death by deliberate underfunding.

    I have previously provided a link to Margaret Thatcher’s 1982 secret Cabinet Papers, “The Longer Term Options” where these papers spell out the means to privatise the whole of our public services in detail.

    The Liberaldemocrats also wrote their own version in the “Orange Book” but in less detail.

    So lets not kid ourselves, the Neo-Liberal agenda has been the slow transformation away from public sector provision to the private sector, and now TTIP will enshrine in law the final segment of those policies to ensure that corporate power can hold future governments to ransome.

    The people of this country need understand the complicity of all the Neo-Liberal poiliticians who are openly selling the people of this country down the river.

    The evidence is all there for everyone to see, so they need to stop burying their heads in the sand and start doing something about it.

  4. I think that Norman Lamb is a first-rate minister and when I listened to him on the House of Lords Select Committee on Mental Capacity Act 2005 [Parliament TV] on 3 December 2013, I realised just how momentous the changes will be.

    I am still awaiting to know how disabled people under the UN Convention on Human Rights for people wit disabilities will actually translate into real life. The tragic case of Aysha King and his parents who were arrested for disagreement over treatment for their son brought this into sharp worldwide focus.

    That is my chief concern that where local authorities start to interfere with purely medical conditions then we may have many more such cases. The Law Commission identified that the Mental Capacity Act 2005 needed review which is how the Select Committee seems to have been initiated and it was only proposed to be a “one-off” committee. However, in light of the “Cheshire West” ruling about DOLS – deprivation of liberty safeguards” and a potential new “Bournewood Gap” arising due to the overlap of the Mental Health Act 1983 [as amended 2007] and Mental Capacity Act 2005 people might find themselves trapped in virtual imprisonment as it was claimed a gilded cage is a gilded cage.

    That to me seems to be the essence of what needs to be resolved. The Law Commission said that it is hoped to bring out a consultation in 2015 and I await this with eager anticipation as I believe that what Norman Lamb and the disability rights campaigners have done has been to empower the vulnerable so that they can have a say in their own lives.

    The Mental Capacity Act 2005 is theoretically one of the most potent pieces of legislation but it is not actually the same throughout the UK. This is of concern to me.

    I do hope that someone looks at this with new eyes.

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