Princes William and Harry break mental health taboos for a new generation | Simon Wessely

Big boys don’t cry, so I was told as a child. But has that always been the case? Nelson’s captains as they made their slow way towards the French fleet at Cape Trafalgar certainly didn’t think so. Many had wept when first shown the battle plan. Tears were not unmanly – far from it. Nelson’s captains were “men of feeling”, part of the culture of sensibility. And this wasn’t just an affectation of the gentry: jolly Jack Tar wasn’t always jolly, and wept buckets on numerous occasions captured in contemporary accounts.

Politicians such as Edmund Burke and Charles James Fox were also liable to burst into tears in moments of high parliamentary emotion, as shown in many satirical drawings. As Thomas Dixon describes in his splendid Weeping Britannia: Portrait of a Nation in Tears, it was not until the Victorian era that stoicism replaced sensibility, and the cult of the “stiff upper lip” was born. And it wasn’t even British – the phrase had been popular in the United States for several decades before it first made an appearance over here.

Now Princes William and Harry have called for the end of the British stiff upper lip culture. And there is much to welcome in this, even if theirs is by no means the first such call – John Lennon being an early advocate in 1970, reminding people that “men hurt” and the therapeutic value of tears. We know for example when dealing with grief and bereavement that repressing memories, not talking about the death of a loved one or avoiding reminders for a long period of time can sometimes prolong grief and its consequences and make things even more complex.

Our own research has shown that after traumatic tours of duty many people in the services find sharing difficult experiences with their mates, and to a lesser extent their families, immensely helpful. Likewise, the vast majority of those living in London during the 7 July 2005 terrorist bombs said that they dealt with their feelings of anxiety and upset by talking a great deal to friends, relatives and colleagues.

[embedded content]

But equally, we have also shown that this should be done at a time and a place of your choosing, and preferably to someone who knows you, or is at least part of your social circle and network. At other times, most particularly in the immediate aftermath of trauma, exhortations that it is “better out than in”, as happened with the vogue for what was known as single-session psychological debriefing, not only failed to reduce distress; it often made it worse. Sometimes it is better to talk about family and football until the person is ready for something more difficult.

There is no correct way to deal with trauma and grief – and we should never forget that most people most of the time cope with horrendous adversity without any help beyond their own social networks. People are more resilient than professionals think.

Everybody deals with trauma and grief in their own way, and that’s how it should be. These are painful, sometimes gut-wrenchingly painful, experiences, but eventually it will happen to all, and we should not be, and are not, in the business of pathologising a normal experience. Talking to others at your own time and pace is one way to deal with this, but not the only one.

However, sometimes the pain never eases, and perhaps people will slip into depression, unusual behaviours, or alcohol. Then the evidence does show that it is good to talk, and continued avoidance or repression can just perpetuate suffering. And sometimes it is OK to talk to what Prince Harry called a “shrink”. I think I prefer myself to be called a psychiatrist, but frankly, it doesn’t really matter what we are called so long as people feel able to get the help they need.

So there can be no doubt that having such high-profile young figures as princes William and Harry talking about mental health and their experiences of it can only be a good thing. They belong to a generation that definitely “gets” mental health much more than my generation did. There is nothing intrinsically wrong with having that much parodied and perhaps slightly mythical “stiff upper lip”, but lips sometimes need to be unbuttoned, especially in times of trouble.

So when I saw Prince Harry come to King’s College London last month and interview three ex-service personnel who had experienced significant mental health problems as a result of their experiences of war, it was clear he was speaking from the heart as much as he was appealing to the head. He’s a powerful role model and has a reach that we can only dream of.

Similarly, his brother means what he says when he talks of ending the taboo around talking about important issues such as anxiety, saying how in the past that has been seen as a sign of “weakness”, and how touring schools with his wife Catherine has inspired them. He said that seeing children talk about some “quite difficult subjects in a really clear and emotionally articulate way” had given him hope that things were changing and “there is a generation coming up who find it normal to talk openly about their emotions”. Indeed so. No, it’s not rocket science. No, it won’t eradicate all mental disorders and no, it won’t work for everyone. But it’s a good place to start.

Princes William and Harry break mental health taboos for a new generation | Simon Wessely

Let’s applaud Simon Stevens: the NHS boss with a plan | Deborah Orr

One trouble with dropping targets is that such a decision tends to create a target. The head of NHS England, Simon Stevens, has outlined many sensible goals in his proposals for the future of the health service. But attention has focused on one thing. In order to take the strain off A&E departments and improve cancer treatment, Stevens has decided to drop the target whereby 92% of routine surgery is carried out within 18 weeks of a GP referral. The moment that some ghastly failure can be personalised in the form of an iconic victim of this change, Stevens will be held personally responsible. He is the target now.

Why is Stevens taking this risk? Largely because the government has made it clear that the extra funding Stevens needs will not be forthcoming. But it’s also another attempt at a nudge, to GPs and to patients. People can be aggressively passive about their health. They want doctors to fix it for them. GPs are wary of berating patients into losing weight and exercising more, especially now, when patients have read on the internet all about the operation they can get. The promise of elective surgery within 18 weeks, I’m afraid, only encourages both GP and patient to kick the can down the road. The hope is that the removal of the target will encourage GPs and patients to opt first for physiotherapy, which is what all sensible people should be doing anyway.

Some of the problem is with us, and our demands. We trail off to the GP with our colds and beg for antibiotics

Around 150 urgent treatment centres are being planned, to take the strain off A&E, which NHS chiefs say still attracts about 3 million people each year with minor ailments. Stevens is hoping to persuade all GP practices to offer evening and weekend appointments, so that A&E departments don’t become one-stop-shops over the weekend. Astoundingly, Stevens is also demanding that all A&E departments should introduce “comprehensive front-door clinical streaming”. Here in my metropolitan elite bubble, I’d imagined that all A&E departments had been assessing all walk-ins by medical need for decades. It’s easy to forget just how much sheer inertia is inevitable when dealing with a beast as large and complex as the NHS.

Stevens also addresses the system’s two most glaring failures – the lack of integration with social care and the relatively slender access to mental health services. On the first, Stevens aims, through closer coordination between hospitals and councils, to free up potentially 3,000 hospital beds. On the second, the aim is to provide talking therapies to 200,000 more people. These are ambitious goals. Considering the lack of investment, they are valiantly optimistic. Sometimes, people doing tough work need a bit of encouragement and applause. Stevens is one of them.

‘Some of the problem is with us, the users, and our demands. We trail off to the GP with our colds and beg for antibiotics; we call ambulances because our friend is very drunk.’ Photograph: Yui Mok/PA

There is a great deal of cognitive dissonance to Britain’s relationship with the NHS. Yes, we love it. No surprises there. It’s worth loving and not only for sentimental or socialist reasons. All but the most cock-eyed of diehard free-marketeers are obliged to bow to the evidence and admit that the NHS is the most cost-efficient health service in the world. Many politicians have struggled to come up with alternative funding models and had to admit that nothing is really worth the hassle it would cause. Insurance-based schemes around the world have been scrutinised and the conclusion is pretty much always that these simply drive up the cost of healthcare generally, with the US a particularly abject example.

Yet at the same time, our love for the NHS is sometimes skin-deep. When things go wrong or are disappointing, this is seen as proof that the service is falling apart, hardly ever that medical problems can be complex and baffling, or that people are not always the most reliable witnesses to their own problems. There’s still a great deal of suspicion about change.

Stevens has come up with a solid plan, and everyone’s up in arms because operations that might not work are being sidelined in favour of restorative exercises that probably will, if only people commit to carrying them out. Why is this supposedly awful thing being done? Just so that people who have been knocked down by cars or people with cancer can have their actual lives saved. Just so that hospitals don’t have to farm operations out to private providers simply to hit their targets on not always terribly necessary operations.

Some of the problem is us, the users; our own expectations and demands. We have this precious, amazing resource. We stand with it and see the government as its enemy. Yet we trail off to the GP with our colds and beg for antibiotics; we call ambulances when our friend is drunk; we’re astounded when our neighbour reveals himself as proficient in first aid.

Right now, there’s a hullabaloo because elderly people with some money behind them are expected to pay for people to help them with things they can no longer do for themselves. This, apparently, punishes “the thrifty”. How can having the wherewithal to pay for things you need be “a punishment”? Sometimes, the basic problem is that we want the best but we don’t want to pay for it. Full stop.

Let’s applaud Simon Stevens: the NHS boss with a plan | Deborah Orr

Simon Stevens" NHS gamble is probably the right choice - but price could be high | Richard Vize

The NHS plan for the next two years represents a perceptible contraction of the health service’s offer to the public.

The proposals in Next steps on the NHS Five Year Forward View, published on Friday, are shaped by shortages of money and staff.

Simon Stevens, the NHS England chief executive, has burned through much of his political capital in disputing government claims about whether the NHS has been given all the money it asked for, so this was not an opportunity to push for further cash.

So in the face of the unrelenting pressure of the government’s austerity programme and barely controlled hospital debt, he is gambling that politicians and the public will stomach longer waits for routine surgery if the health service can deliver better performance on cancer treatment, A&E waits, mental health services and GP appointments.

In the wake of slipping cancer treatment times and the recent outcry over the death of a child waiting for urgent surgery, this is probably the right choice. But the price could be high.

Allowing elective surgery times to slide over many years was what led to hundreds of thousands of patients waiting months for operations by the time New Labour came to power in 1997, elected partly on its pledge to slash waiting lists. It would be a serious blow if the NHS returned to the days of people dying while waiting months for heart surgery, and many more forced to endure avoidable pain and disability.

Access to some of the latest approved drugs is also to be delayed – in breach of a commitment in the last Conservative manifesto to speed up access.

Stevens is anxious to reassure the public that performance will not slide back to that of the 1990s, but it is difficult to see how growing waiting times will be arrested and reversed in the coming years.

The plan makes some brave assumptions about the ability of the NHS to expand its workforce, including 4,000 more nurses through improving staff retention – turning round a recent trend – and up to 2,000 more nurses returning to practice.

There is yet another pledge to increase the number of GPs substantially, despite little discernible progress. However, concerns are growing that staff shortages will be exacerbated by EU staff heading back to the continent in the wake of the Brexit vote.

More promisingly, the plan may well mark the beginning of the end of the internal market. It names nine areas being considered as pioneering “accountable care systems”, with NHS organisations and local authorities working together as an integrated health system.

These areas will have considerably more control over how they deliver their healthcare, and will be effectively freed from the endless focus on contracts rather than patients imposed by the purchaser/provider split.

However, doing so will require ever greater legal contortions to simultaneously stay within the law while circumventing it. This is a necessary bodge, as it will be years before anyone attempts another NHS reform bill, but these workarounds cannot be sustained indefinitely.

Everyone will now be working in Sustainability and Transformation Partnerships, and NHS England makes clear that anyone who fails in their duty to collaborate can expect to be handled roughly.

In the absence of more money, the alternative to Stevens’ plan would be a steady atrophying of performance across the entire health service. Instead, NHS England is pushing forward on the key priorities of emergency care, cancer treatment, mental health and primary care, and allowing routine surgery to pay the price.

But many of its promises look optimistic, and there is a danger that the slide in surgical performance will eventually reverse years of progress.

For the time being this can be portrayed as a tactical move, but with austerity set to last well into the next decade, there is a risk that the NHS will cease to be a comprehensive service.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Simon Stevens" NHS gamble is probably the right choice - but price could be high | Richard Vize

Simon Stevens" delivery plan for the NHS explained

The chief of NHS England, Simon Stevens, has pledged to make an array of changes to benefit patients in his proposals for the future of the health service.

In the delivery plan for his Five-Year Forward View, he sets out the way in which providers of NHS care must overhaul their working practices, despite the unprecedented pressures they are facing and the service having less money than he believes it needs to do its job properly.

The changes include:

• Creating an England-wide network of about 150 urgent treatment centres to take the strain of overcrowded A&E units, which NHS chiefs say 3 million people a year visit unnecessarily with injuries and minor ailments. The centres will be open for 12 hours every day of the week and be staffed by GPs, other doctors or experienced nurses. “They offer patients who do not need hospital A&E care treatment by clinicians with access to diagnostic facilities that will usually include an X-ray machine,” the delivery plan says.
  


• Every A&E must put “comprehensive front-door clinical streaming” in place by October, under which nurses or doctors assess how unwell patients are and direct them to the most appropriate service. New GP services at emergency departments will be one option, paid for by £100m announced in the recent budget. This aims to give A&Es more time to look after the sickest patients, who will often be frail and elderly.
  


• GPs will have to offer evening and weekend appointments across the whole of England by March 2019, despite family doctors’ concern that there is too little demand from patients, especially on Sunday afternoons, and too few of them. NHS England are also pledging to put 3,250 extra GPs, plus 1,300 clinical pharmacists and 1,500 more mental health therapists, into GP surgeries by 2019, though sceptics have questioned where the new doctors will come from.
  


• An overhaul of the NHS 111 telephone advice service aims to increase the proportion of calls that are answered by doctors, nurses and mental health specialists from 22% to 30% by March 2018. A new NHS 111 online service later this year will let patients enter symptoms and receive “tailored advice on management” of their illness.
  


• Hospitals and local councils will work together to cut the number of patients stuck in hospital, despite being medically fit to be discharged, because of inadequate local social care. The aim is to free up 2,000-3,000 hospital beds so that hospitals can admit patients classed as a medical emergency quicker than is currently the case.
  


• Early diagnosis of cancer should be improved through the creation of 10 regional rapid diagnostic and assessment centres. They aim to ensure that by 2020 every cancer patient is diagnosed within 28 days and, it is hoped, ensure that an extra 5,000 people survive their cancer over the next two years. A £130m expansion of precision radiotherapy will see 42 hospitals acquire or upgrade their equipment to achieve this.
  


• Improvements to mental healthcare aim to provide “talking therapies” to 200,000 more people by March 2019, improved services for children and young people, including 150-180 extra inpatient beds to avoid under-18s having to travel far from home to get care, and the creation of four new mother and baby units to help women suffering postnatal psychological or psychiatric problems. The number of A&E units with mental health specialists on duty 24/7 should rise fivefold to 74 by 2019, and there will also be new dedicated mental health services for traumatised military veterans.
  


• Millions of people in up to nine areas of England should receive better, more joined-up care when hospitals, GP surgeries, mental health and ambulance services and social care providers in each region link up to become the first wave of new “accountable care organisations”, which provide fully integrated care for all of a patient’s needs. The frontrunners to get approval to pioneer that approach are Frimley Health in Surrey; Greater Manchester; South Yorkshire and Bassetlaw; Northumberland; Nottinghamshire; Blackpool and Fylde Coast; Dorset; Luton, Milton Keynes and Bedfordshire; and West Berkshire.

Simon Stevens" delivery plan for the NHS explained

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

The algebra is simple. The NHS is having another terrible winter. It does not collapse, but “spills demand” on to the next line of defence, local government welfare. But while the NHS gets more money annually from the Treasury, local government gets less, some 30% less since 2011. It cannot cope with the new pressure.

The equation resolves itself into rationing, by quantity and quality: fewer care places, fewer home visits and fewer district nurses leads to more bed-blocking, fewer operations, longer trolley waits.

Tory Surrey is a responsible supplier of post-hospital care. Like all councils, it is allowed by the Treasury to increase its council tax by 5%, specifically to boost its care budget and thus ease pressure on the NHS – which the Treasury is responsible for funding. Surrey county council regarded this as nothing like enough. It therefore activated its statutory right to hold a referendum on a 15% increase.

Far from showing delight at a wealthy council accepting this burden, the Tory government was appalled. Tories do not increase taxes. The chancellor (and Surrey MP) Philip Hammond duly did what Jeremy Corbyn called a secret deal. If Surrey abandoned its referendum and the 15% hike, it could retain revenue from a different tax – the local business rate, which normally went to the Treasury. That is, the Treasury would in effect spend more on health and care in Surrey, but secretly and, so far, just for Surrey.

This is the stuff of a banana republic. If Britain wants to spend more on health and elderly care, it should raise it and spend it honestly. Instead, the Treasury is running around its fiscal A&E department, staunching the flow of political blood by slamming on plasters wherever a patient screams or twists an arm.

Leaked Surrey council tax texts allow Corbyn to ambush May at PMQs

Some might argue that an NHS free at the point of delivery has had its day. New disciplines and incentives, through fees or insurance or more prevention, must constrain marginal demand. But for the time being, it makes no sense to squeeze the NHS at the top – where politicians are exposed – and dump its problems on to local government and different funding streams at the bottom. It wastes money and distorts priorities. It is illiterate public finance.

If Surrey is harbinger of a new health and care service, and business taxes are to relieve an ever-burgeoning NHS, so be it. But few places are as rich as Surrey. Revenue will have to be redistributed from rich to poor areas. In other words, it is not just the NHS that needs rethinking, but the whole murky world of local government finance.

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

Former Tory health minister defends Simon Stevens over NHS winter crisis

A former Conservative health secretary has said it was unfair for Downing Street to hint that the NHS England boss, Simon Stevens, was to blame for the winter crisis gripping the health service.

Stephen Dorrell, now chair of the NHS Confederation, issued the rebuke after Stevens told MPs on Wednesday that Theresa May was “stretching it” by saying the health service had got more money than it had requested.

Sources close to May had suggested to the Times that Downing Street thought Stevens was “not enthusiastic” and was annoyed by his political interventions, particularly on social care funding. The prime minister’s spokeswoman later denied relations were frosty, saying May had full confidence in Stevens.

Dorrell said he believed that any allegations of political interference, and the insistence that the NHS had received the funding it had requested, were not fair to Stevens.

He told BBC Radio 4’s Today programme: “I do think it is unfair on him, because he’s made it clear from the beginning … He set out, he is the author of, the five-year forward view; he is the author of the government’s policy of the health service as part of a broad range of public services.

Theresa May and Jeremy Corbyn clash over NHS at first PMQs of 2017

“He’s been the strong advocate of the need to integrate, to change the way we deliver health and care in our communities in order to deliver more joined-up services with proper emphasis on care as well as on the essential elements of acute medicine.”

Dorrell said the government “should be addressing the evidence about what is happening on the ground rather than engaging in a rather high-profile discussion about, frankly, what sound to the public like telephone numbers of public expenditure”.

Speaking to the Commons public accounts committee on Wednesday, Stevens said “there are clearly very substantial pressures, and I don’t think it helps anybody to try and pretend that there aren’t”. He pointed that out the extra £10bn the government had referred to was being granted over six years, meaning the health service had less than it had asked for in its five-year-plan.

Stevens even appeared to take aim at May’s experience as home secretary, saying that dealing with challenges posed by an ageing population was “quite different to the criminal justice system”.

The row came as it was reported that at least 23 NHS trusts in England had declared a black alert in the past week, while freezing temperatures are expected to exacerbate the strain on the UK’s overstretched hospitals and heath services.

On Wednesday, May said claims by the Red Cross that the health service was suffering a humanitarian crisis were “irresponsible and overblown” in a series of clashes with the Labour leader, Jeremy Corbyn, over the issue. “Our NHS, Mr Speaker, is in crisis, but the prime minister is in denial,” Corbyn said.

The shadow health secretary, Jon Ashworth, published a letter he sent to May about Stevens’ performance, asking if she agreed with his assessment of funding levels and the effects of cuts to social care.

“Failure to take Simon Stevens’ warnings seriously would risk deepening a crisis that has already pushed the NHS to breaking point,” he wrote.

Former Tory health minister defends Simon Stevens over NHS winter crisis

Simon Stevens announces program to give patients money for care - your views

Billions of lbs of NHS and town hall budgets are to be handed above to sufferers to pick health and social care services in the neighborhood, in a dramatic modify of policy getting unveiled by the new NHS England chief executive.

Simon Stevens advised the Guardian that “north of 5 million sufferers” could every single have a individual combined wellness and social care spending budget by 2018, paid for by “billions” of lbs supplied by the NHS and local councils.

The move will see older folks, disabled young children and these with significant mental well being difficulties or finding out disabilities supplied person pots of cash to devote as they see fit on well being and social care companies, in an attempt, in element, to preserve them out of hospital.

Some patients’ budgets, from subsequent April, will be as small as a few hundred pounds, however most are probably to get more than £1,000, with a tiny variety who have extremely complex demands obtaining much more than that.

What do you consider? Can it work? Will the move alleviate pressure on hospitals? Ought to sufferers have more management above their care? Or, ought to there be a lot more investment in solutions? Share your thoughts in the comment part beneath or tweet us @GdnHealthcare

Simon Stevens announces program to give patients money for care - your views

Finish this sugar rush it is the only way to tackle the weight problems crisis | Simon Capewell

‘Added sugars are hidden all over the place: often there are four teaspoons of sugar in a tin of soup, 5 in a common Tv dinner, 6 in a yoghurt, 9 in a can of cola.’ Photograph: Matthew Horwood/Alamy/Alamy

A third of British young children and two-thirds of British grownups are obese or obese. Diabetes levels have doubled in the past two decades. Nevertheless, contrary to common belief this is not mostly due to our more and more sedentary lifestyles. It primarily outcomes from excess calories in our food and sugary drinks.

Extra sugars are hidden all over the place in modern food: usually there are 4 teaspoons of sugar in a tin of soup, 5 in a typical Television dinner, six in a yoghurt, 9 in a can of cola. At greatest, these extra sugars are empty calories with zero dietary worth at worst, they are toxic.

Typical sugar comprises glucose and fructose. Several scientists are convinced that the current substantial quantities of fructose consumption are harmful. Fructose molecules are processed in the liver into unwanted fat. This triggers the release of insulin (producing a pre-diabetes state) and raises blood pressure. Sort two diabetes could suggest a existence of increasing complications and an earlier death from a heart attack, stroke, cancer or dementia. Each week, this scientific proof is strengthened.

My daughter’s friend Susan (not her genuine title) is a delightful 11-yr-outdated, but a little chubby. Her college not too long ago scheduled an further hour of games for her class each day. Susan might burn up off an additional 100 kcal at every session, a weekly complete of 500 kcal. But on the way property on Fridays, Susan stops off for her reward: a cheeseburger. Yes, you’ve guessed it, 500 kcal in five minutes. Plus low-cost sugary cola, a further 110 kcal. When residence, Susan sits down to view television and absorbs the hefty advertising of junk food, sweets and sugary drinks. If her mum is functioning late, Susan heats up a Tv dinner (400kcal), washing it down with a can of sugary pop (140kcal). And so her fat increases. Like millions of other children in Britain right now.

Meanwhile, multibillion-pound industries get wealthy via manufacturing, advertising and retailing junk meals and sugary drinks. Over all, they worry any regulation that may possibly threaten long term income. So they focus on other (ineffective) options, such as Andrew Lansley’s “responsibility deal” amongst 2010 and 2014, and market “nudging” as a stylish approach to alter behaviour. Public overall health scientists had seen voluntary agreement video games played previously. In 2010, they predicted it would not work.

The four years of the accountability deal largely concerned industry and government sitting about tables dreaming up higher-profile pledges to “cut a billion calories” or minimally lessen sugar content in isolated items. The deal gave businesses a good deal of publicity. The taxpayer has hence funded market PR, but weight problems has elevated. And just two weeks ago came more revelations that many effectively-identified organizations had reneged on their pledges.

Additionally, the deal was employed by government and sector as an excuse to reject far more successful approaches. Without a doubt, the tactics utilised by Massive Tobacco, Large Booze and now Big Food lobbyists look comparable: denial, delays, detours and dramatic distractions.

Government attempts to lessen calories and sugar have failed (although industry apologists attempt to disagree). So what is needed now? Massive Tobacco had 5 glorious decades of unregulated profit just before being managed by addressing the “3As”: affordability (taxes and value rises), acceptability (marketing and advertising bans and warning labels), and availability (licensing and smoke-cost-free legislation). These are probably transferable to junk food or sugary drinks.

Campaigners have urged the health secretary, Jeremy Hunt, to impose a sugary drinks duty, a advertising and marketing ban, mandatory site visitors light labelling, and progressive sugar and saturated fat reductions in junk meals. They also want him to lessen portion sizes, finish market sports activities sponsorship and set up an independent food policy institute.

Hunt, a gifted and ambitious politician, is caught among the rock-like Scylla of market lobbyists and the Charybdis whirlpool of public view, which now supports sugar regulation. My funds is on the whirlpool.

Finish this sugar rush it is the only way to tackle the weight problems crisis | Simon Capewell

These days in healthcare: Simon Stevens speaks at the NHS Confederation annual conference

Hello and welcome to the dwell blog from the Guardian’s local community for healthcare specialists. We are reporting from the NHS Confederation yearly conference, which will hear speeches from Simon Stevens, chief executive of NHS England, Rob Webster, chief executive of NHS Confederation and Sir Stuart Rose, NHS adviser and former chief executive of Marks and Spencer.

In advance of the occasion, Dennis Campbell, health correspondent for the Guardian, wrote that only an injection of income can avert an NHS crisis. He writes:

Abruptly the rhetoric around the NHS has got extremely dramatic. The support is “at a defining second”. Says who? None other than Simon Stevens, NHS England’s new chief executive. His self-declared mission: to make the NHS sustainable. No pressure, eh? Interestingly, the ex-Labour unique adviser personally wooed by David Cameron to consider the occupation appears relaxed about being noticed so broadly as the service’s saviour.

He continues:

The Much better Care Fund, which is due to get almost £2bn out of hospitals’ £40bn-odd budgets from April 2015 in purchase to set up new services elsewhere, is a specific issue. Hospital bosses – doubtless self-interested, declare the expected 15% reduction in emergency work just is not achievable. The King’s Fund says it is “totally unrealistic” to count on that the necessary new solutions will have been produced elsewhere by April to permit this kind of a big and overnight switch of sources to occur painlessly.

Campbell has also reported that Simon Stevens is expected to say thatthe NHS must turn into planet leader in personalised medicine. Stevens will use his first main policy speech to embrace the prospective of what he calls an ongoing “worldwide health care revolution” that holds out the prospect of sufferers obtaining a much better likelihood of beating conditions this kind of as cancer.

And, Tim Kelsey, director of patient involvement at NHS England, has written that a much better NHS demands freedom for leaders. He writes about the Hurley Group – an NHS organisation that runs a variety of practices and GP stroll-in centres across the capital – which has developed a services that allows patients to seek the advice of their GP employing an on the internet instrument that captures a history which the GP can use to triage remotely.

He adds:

The well being and care services needs to learn how to liberate employees and patients – tapping into this power source is key to sustainable substantial-top quality outcomes for individuals, carers and clientele. I have made a emphasis on promoting transparency (greater data) and participation (frequently via innovative makes use of of technological innovation) as crucial to a wellness service centered on the requirements of the people it serves, but they are also instruments of leadership.

Tim Kelsey says the health service requirements to understand how to ‘liberate employees and patients’.

These days in healthcare: Simon Stevens speaks at the NHS Confederation annual conference

Is Simon Stevens appropriate to back local community hospitals?

There will not be a return to an era exactly where hospitals were staffed by matrons who ruled with a rod of iron, writes Malcolm Prowle. Photograph: George Freston/Getty Photographs

In a current interview, Simon Stevens, the head of the NHS in England, appeared to mark a change in policy by calling for a shift away from large centralised hospitals and in the direction of community hospitals with new models of care created all around smaller local hospitals. In some methods this sounds radical but closer examination may suggest that it is just a phase on an evolutionary pathway.

For 60 many years, the bedrock of the NHS was the district standard hospital (DGH), which delivered a variety of hospital companies, other than specialised tertiary providers at university hospitals, to a regional population of possibly half a million folks. However, in recent many years this procedure has started to change with a far more varied pattern of providers developing, incorporating DGHs specialising in particular facets of healthcare, expanded major care centres, walk in centres and community hospitals.

Community hospitals are properly positioned to help patients on their complicated journeys of care through the health and care technique. They can be noticed as a nearby hub for a variety of easily accessible wellness providers and may well also offer signposting to other solutions such as individuals provided locally by the third sector. Community teams can also assist to prevent emergency admissions to acute hospitals and can play a significant role in supporting the reduction of hospital delayed discharges.

Nonetheless, this does not imply a return to an era where hospitals had been often staffed by matrons who ruled with a rod of iron and exactly where general practitioners popped in to do a bit of schedule surgery. Neither does it indicate that many existing, and a lot loved, community-based hospitals will not be closed the place they are identified to be obsolescent, inappropriate or just plain outmoded. This will undoubtedly make a great deal of local opposition but, personally, I have observed scenarios in which the public opposed the closure of a hospital which was not just unsuitable but unsafe.

However, new local community hospitals will carry on to be built. All through the nation it is possible to discover examples of exactly where an outdated community hospital has been closed and replaced, a few years later, by a new one particular nearby.

Complicated health care and surgical care will nonetheless be offered at large hospitals, in which doctors can specialise in particular elements of medicine and can have better clinical outcomes than in hospitals the place no such specialisation requires location. Nevertheless, other services this kind of as care of older folks, lengthy-term care and patient rehabilitation may be far better undertaken in the significantly calmer atmosphere of a community hospital. In some instances, diagnostic and some therapy actions for acute patients may well also be presented at a spot far more hassle-free to the patient.

Some will argue that smaller community hospitals are inherently significantly less productive due to the fact of their dimension but this might not be the situation. Usually larger organisations (this kind of as a DGH) can have inefficiencies that are identified in several largeish bureaucracies and tiny hospitals can have higher scale and flexibility. It is, consequently, a debateable point as to whether local community hospitals will cost more to run and will need added funding.

There will be strong barriers to the notion of more local community hospitals. Not all healthcare experts will be pleased to operate in such units and could see them as boring considering that they are not functioning at the cutting edge of healthcare. Consequently, they might see this as a block to their individual profession prospective customers.

Several individuals, including myself, will look on neighborhood hospitals favourably as a area for elderly family members to invest the final years of their lifestyle. The calmer setting and the higher degree of familiarity with nursing and other staff will be a welcome alter from the hustle and bustle of the huge hospital.

A single may wonder why Simon Stevens has selected this controversial topic to mark one particular of his earliest interviews as head of the NHS. Could it be that community hospitals are extremely popular with the public and that this will generate good news for the NHS even however, as currently observed, the variety of local community hospital being proposed is very various from that of the romantic past? Alternatively, is it just a signifies of distancing himself from the previous NHS regime by a substantial change in policy? Time will tell how far the configuration of the NHS will alter as a consequence.

Malcolm Prowle is professor of business efficiency and co-director of the Wellness and Social Care Finance Study Unit at Nottingham Business School

What do you consider of Simon Stevens’s programs to finish centralisation in the NHS and back neighborhood companies? Have your say.

Are you a member of our online neighborhood? Join the Guardian healthcare network to get regular emails and exclusive offers.

Is Simon Stevens appropriate to back local community hospitals?

Simon Stevens: NHS need to back nearby hospitals Twitter response

The NHS should move away from large centralised hospitals and in direction of neighborhood services to care for folks in their own communities, the new NHS England chief executive has mentioned. Simon Stevens mentioned there necessary to be new designs of care created close to smaller sized neighborhood hospitals. Right here are some of your tweets responding to his comments:

@sajajohnson @GdnHealthcare Needs a lot more income to fund this and the PFI for the megacentres previously in existence. Who will workers them?

— Dr John G Hughes (@johnghughes3) Might 30, 2014

@GdnHealthcare Good! but a lot more essential to cease enormous economic wastage on the tendering procedure NHS vs Private

— jenny.bremner (@BremnerJenny) May possibly thirty, 2014

@GdnHealthcare centralisation is the way we get better concentration of expertise &amp efficiency with dilution high quality of care suffers

— Julie Longworth (@bushbytiger) May thirty, 2014

DH’s programs for 15-thirty specialised hospitals would have wrecked neighborhood health economies all over country. Good to see Simon Stevens rowing back

— Clive Peedell (@cpeedell) Could 30, 2014

@GdnHealthcare Final handful of years have been about hospitals feeling extremely threatened – stifles innovative response. This will help greater considering

— diana smith (@mulberrybush) May thirty, 2014

Agree with @mulberrybush NHS must start off with patient and operate backwards, like a business. Focusing on primary care is key @GdnHealthcare

— The Information Surgery (@DataSurgeryUK) May thirty, 2014

@nedwards_1 @HPIAndyCowper thrilling to see Simon Stevens advocating for smaller hospitals as a centrepoint in local communities…

— John Myatt (@JMMyatt) May thirty, 2014

@GdnHealthcare Also need functional oversight to accessibility #innovation, research &amp new remedies &amp involvement in determination creating @SDenegri

— Rachel Joynes (@investigation_ramble) Could 30, 2014

Calm down every person. Simon Stevens not promising new hospitals in every single town. May possibly just be giving lifeline to some smaller DGHs although

— Alison Moore (@AliJaneMoore) May thirty, 2014

New NHS CEO says NHS is at a defining minute but no mention of culture or patient security. http://t.co/R61us3KdCG

— Gary Walker (@garywalkeruk) Could 29, 2014

Much more political irony !! It looks this Simon Stevens was a former advisor on health to Bliar, the man that closed all the modest hospitals

— Mark Bowden (@markbowdn) May possibly thirty, 2014

@GdnHealthcare he is not far off, NHS is misaligned with support delivery for persistent care, get that appropriate, care improves, charges will drop

— Christian Symonds (@chris_symonds1) Could thirty, 2014

Argued on BBC information channel that Simon Stevens both conservative (conserve nearby hosps) and radical (transform out of hosp care)

— Chris Ham (@profchrisham) Could thirty, 2014

@GdnHealthcare nevertheless makes it possible for them to push on with privatising services &amp tendering out, so no wonderful change in the greatest aim, for me

— Mark Robertson (@TheRobbo1) Might thirty, 2014

@GdnHealthcare Stevens’ comments present that two many years on from Health Act getting passed, NHS architecture nonetheless evolving and in state of flux

— Ben Nunn (@BenNunnUK) Could 30, 2014

@SocietyGuardian @GdnHealthcare all extremely well but absolutely nothing can disguise the fact that if the NHS is not funded properly services will be reduce

— Mary Brooks (@MarygBrooks) Could thirty, 2014

@sajajohnson @GdnHealthcare encountering outstanding nearby post op rehab care with my mum, it is targeted, effective + investing in recovery

— Sally Crowe (@sally_crowe) May 30, 2014

Have your say by commenting under the line or tweeting us @GdnHealthcare

Simon Stevens: NHS need to back nearby hospitals Twitter response

Simon Stevens: NHS should end mass centralisation - your views

The NHS need to finish mass centralisation and alternatively increase its regional companies to treat men and women in their own communities, Simon Stevens, the new chief executive of NHS England has explained.

In a marked reversal of present policy, Stevens stated the NHS must broaden its neighborhood services because numerous sufferers are not handled with “dignity and compassion”.

Several wellness solutions in western Europe were previously successfully serving their regional communities with no centralising almost everything, he extra. He informed the Daily Telegraph on Friday: “A variety of other countries have discovered it possible to run viable nearby hospitals serving smaller sized communities than sometimes we believe are sustainable in the NHS.”

What do you consider? Need to there be a lot more investment in local community companies? How can they help? Or, must there be much more hospital closures? Share your thoughts in the comment area under or tweet us @GdnHealthcare

Simon Stevens: NHS should end mass centralisation - your views

NHS boss Simon Stevens criticises lack of diversity in management

The new chief executive of the NHS, Simon Stevens. Photograph: Owen Humphreys/PA

The NHS’s new boss has criticised the lamentable lack of managers from black and ethnic minority backgrounds concerned in working hospitals which, he warned, meant they are not reflecting the communities they serve.

Simon Stevens, who began last month as chief executive of NHS England, explained he is so concerned that he is building a prepare to tackle the service’s inaction over the lack of diversity in its leadership, which he claimed was holding the NHS back.

Regardless of pledging a decade ago to tackle the stark imbalance the NHS’s record was bad and worsening, Stevens stated in a speech at the King’s Fund wellness thinktank on the want for cultural adjust and robust leadership.

“It can not be right that 10 years soon after the launch of the NHS race equality program, although 41% of NHS personnel in London are from black and ethnic minority backgrounds, similar in proportion to the Londoners they serve, only 8% of believe in board directors are, with two-fifths of London trust boards getting no BME directors at all.

“Related patterns apply elsewhere, and have truly been going backwards”, Stevens additional.

The chronic lack of non-white faces in senior positions meant the NHS was missing out, he added. “Yet diversity in leadership is related with much more patient-centred care, greater innovation, higher personnel morale, and entry to a wider talent pool”, he informed an audience of about 250 NHS leaders.

He himself had benefited in his career from getting had three black bosses and a woman as his line manager, even though they have been all when he was operating outdoors of the NHS, stated Stevens. The 47-yr-old worked as an NHS manager before getting to be a particular adviser to Labour overall health secretaries Frank Dobson and Alan Milburn in the early years of Tony Blair’s government and then with Blair in Downing Street. He has spent the last decade considering that quitting Amount 10 for a senior publish with UnitedHealth, the American personal overall health group.

Sir David Nicholson, whom Stevens replaced on one April, lately recognized the lack of black and ethnic minority bosses across the NHS as one particular of the failings of his eight years in the task.

Stevens has asked an equality and diversity group inside NHS England to come up with concepts to tackle the shortage by the time it up coming meets on 29 July.

In the speech Stevens also hinted for the 2nd time in his number of public appearances so far that he opposes the idea, extensively supported by health policymakers, that specialist health-related and surgical providers ought to be heavily centralised, calling into query the viability of smaller hospitals.

“We want to give careful bodyweight to communities’ own values and preferences for access versus specialisation”, he said, in a coded warning that the push to centralise risked alienating local people.

The turnaround in the fortunes of Hinchingbrooke hospital in Cambridgeshire, which for two many years has been run by the personal healthcare company Circle, showed that smaller district standard hospitals could have a sustainable future, he additional.

NHS boss Simon Stevens criticises lack of diversity in management

Tunisia"s poorest towns left to shoulder burden of hazardous toxic landfill web sites | Simon Speakman Cordall

A refuse dump in Tunisia. The overall health implications of this kind of web sites, which frequently incorporate chemical waste, have raised issues. Photograph: Jeremy Graham/Alamy

Salah Darghouth’s aggravation is visible. “You see that man working on the ninth floor,” says the adviser to Tunisia’s sustainable growth ministry, pointing at a labourer on the half-constructed tower block opposite. “He harasses me. Every single day I observe him and all the other individuals throw their refuse on to the street below – concrete, litter, every little thing.”

Across Tunisia, with the dust of revolution beginning to settle, refuse looms large in the public conversation. Litter, especially plastic bags, has come to dominate the country’s famously dramatic landscape. The problem is felt by all citizens, but none encounter it more acutely than these living up coming to the straining landfill websites.

Ridha Trabelsi, 45, a shopkeeper who lives in the modest Tunis suburb of el-Attar, is a case in stage. “Would you like to reside here?” he asks, gesturing in direction of close by Jbel Borj Chakir, Tunisia’s biggest landfill web site and a source of expanding exasperation. “They explained they were going to shut it last year, but they haven’t. It’s nevertheless right here and it is only obtaining larger.”

The influence of landfills on this kind of areas is difficult to overstate. In 2011, right after the Jasmine revolution, it was the landfill websites at Djerba, Enkhila (near Nabeul), Oued Laya (close to Sousse), Agareb (near Sfax), and the country’s only hazardous waste-treatment plant, at Jradou, that bore the brunt of local residents’ fury.

All had been closed, most of them temporarily, as a end result of violence. Jradou stays shut, and it is unclear where its waste is being handled. Strategies to reopen the Djerba website have triggered far more violence.

In el-Attar, the stench of rubbish chokes the air it sticks in your throat and permeates your clothing. Trabelsi’s son, eight-year-previous Mohamed, is asthmatic. Respiratory sickness is rife.

“When you build a landfill, you create it for a specific time period,” says Morched Garbouj, an environmental engineer and president of the SOS BIAA environmental group. “Right here at Jbel Borj Chakir, that time period ended in 2013. At that level, it need to both have been closed or, at the least, working at about ten% to 20% capacity.”

According to Darghouth, no determination has been taken on the prolonged-phrase potential of Jbel Borj Chakir. “We’re taking delivery of all around two,000 tonnes of waste each and every day. That has to go someplace … We’re just dealing with almost everything on a day-to-day basis even though we perform to implement a bigger strategy.”

“1 of the issues here is that we don’t know what variety of waste we’re dealing with,” says Garbouj. “Elsewhere, waste is separated, here it all will get dumped collectively – chemical, industrial, family and health-related.” Residents and those who make their living scavenging the dump have reported locating blood bags and foetuses in the refuse at Jbel Borj Chakir, a claim denied by Agence Nationale de Gestion des Déchets, which manages waste on behalf of the environment ministry.

“I did not just see them [the diverse types of waste], I dealt with them,” says Kamel Marouani, a former refuse employee. “Chemical, health care, every thing.”

“One of the troubles with all the various types of waste is the leachate it generates [the liquid created at the base by the compressed refuse],” says Garbouj. “Leachate is extremely toxic, so there are stringent controls about how it should be treated and disposed of. Even so, simply because no 1 understands what’s in it, no one understands how it need to be handled.”

Marouani, who was diagnosed with lung cancer in August 2012, worked at Jbel Borj Chakir for 10 years, the previous 5 for a French company, Pizzorno, a single of 3 contractors that handle landfills for the Tunisian government. One particular of his tasks was to work in the 10 leachate basins that surround Jbel Borj Chakir. He was necessary to wade by way of the often chest-high, reeking, black leachate – constructing dams or clearing away the thick foam that forms on the surface of the basin.

SOS BIAA estimates that the value of transporting and disposing of waste at Jbel Borj Chakir was about $ 110-$ 125 (£65-£75) a ton, in contrast with the equivalent cost in New York of $ 86. This was in spite of drastically reduced overheads. Trucks dumping at Jbel Borj Chakir pay Pizzorno $ 15 for every single ton of waste deposited in return for the firm’s experience in managing the web site. Offered that, on an common day, about three,000 tons of waste is deposited, that equates to a day-to-day income stream of $ 45,000. The costs of trucks and labour are billed to the Tunisian government.

In 2011, Pizzorno was the subject of a complaint by the post-Arab spring government’s Commission of Investigation on Corruption and Embezzlement in excess of its dealings with President Zine al-Abidine Ben Ali’s regime. On 15 March, Pizzorno’s five-yr contract with the Tunisian government expired. No choice has been taken on a achievable successor. Pizzorno, which continues to handle the internet site on a caretaker basis, declined to comment on any of the factors raised in this report.

Desta Mebratu, deputy director of the UN Atmosphere Programme’s regional office for Africa, stated: “Disposal in sanitary landfills is the last alternative that need to be deemed … Tunisia is 1 of the 1st African nations that established a national programme on waste minimisation and cleaner production. This programme has led to reduction of a generation of industrial waste and reduction of pollution.”

In el-Attar, minor of this matters. Kids carry on to perform near the landfill website. According to SOS BIAA tests, the local water provide – like all the water inside a 5km radius – continues to be contaminated by fine particles, nitrates and even hefty metals from the dump. Trabelsi seems at the mountain of refuse that dominates the landscape for miles. “We have sick outdated folks. Our youngsters are sick. We can’t continue.”

Tunisia"s poorest towns left to shoulder burden of hazardous toxic landfill web sites | Simon Speakman Cordall

Small is best. The NHS demands to be broken up | Simon Jenkins

‘Even when David Cameron swore he would not introduce any far more meddlesome leading-down restructuring he pushed through an additional.’ Photograph: Stefan Rousseau/PA

Hundreds of asthma victims die needlessly “simply because NHS guidelines are routinely neglected”. Diabetic children’s “lives are at danger since physicians miss threat”. Eleven thousand heart individuals every year “died due to the fact of bad care”. Ten thousand cancer sufferers “die needlessly because of blatant ageism between medical doctors”. And this is just last week. Is this our dear old NHS, or has it become a morticians’ conclave?

All NHS news appears bad. “Cuts are forcing twice the amount of mental individuals” to travel out of spot as two years in the past. 1 in 5 hospitals is dealing with a deficit. GP surgeries are “approaching crisis” with millions left with out a medical doctor. A quarter of walk-in centres are closing. Half the senior posts in A&ampE are now “left vacant”, driving emergency wards “beyond capability”.

The public may reasonably ask if the scandals at Morecambe Bay, Colchester, Mid Staffs and now Panorama’s Old Deanery are exceptions or the norm. Two knights of the NHS, Sir David Nicholson and Sir Bruce Keogh, have the two been scathing in their attacks on the service’s leadership and quality: the former castigated politicians for “wasting many years” on reform and demanded far more “painful change” the latter for the NHS’s inefficiency and ”lack of compassion”. Doctor in the House has given way to Green Wing.

Back in January, the stories had grown so terrible that “crucial NHS chiefs” wrote to the Guardian pleading for an end to the “bash-the-NHS culture”. Little can they have anticipated how futile was their cry. The services is utterly at the tabloids’ mercy, the place a well being story now indicates “Alfred, 69, left sleeping in a chair with dried blood on him … his clothes not altered … soaked in urine … heart assault on the way house”. On Tuesday came a suggestion that the greatest cure for numerous ills might be Buddhist “mindfulness”. It might apply to the NHS.

The public used to profess a quasi-religious faith in the NHS on a par with the monarchy and the British army. Anybody who went to a hospital and was truly cured was not the beneficiary of what a hospital is supposed to do, but of some heroic miracle. The NHS was Britain’s Lourdes, its personnel priests and acolytes (with consultants as bishops). For many years their practices, monopolies and privileges had been divinely ordained and as a result went unchallenged.

That state of grace could not final. At least given that the 1980s, the NHS has been in turmoil as politicians of the two parties struggled to adjust it. Modify grew to become a ruling obsession. There need to be as a lot of “change managers” in the NHS as there are heart surgeons. Even when David Cameron swore he would not introduce “any a lot more meddlesome leading-down restructuring” he pushed through yet another. The surest way to enrage a physician is to inquire if the NHS is now in the appropriate form.

It have to be debilitating for any profession to see its failings trumpeted nationwide, its requirements attacked and its practitioners dismissed as grasping and uncaring. Several hospital trusts encounter economic ruin. As for the pride of the latest reform, primary care, it seems to hover in between meltdown and seize-up.

An growing amount of individuals – like Labour’s former overall health minister Norman Warner – propose the unthinkable: charging something for care, farming out basic exams and procedures to the personal sector, even letting nurses perform straightforward operations. Anything to break the logjam.

Nevertheless one topic that is unmentionable – and as a result untouchable – is the dimension of the NHS itself. A public services that, for a generation, has effectively nationalised its virtues finds it has now nationalised blame for its vices. The place glory after shone down on the Commons dispatch box, now there is only scandal.

It have to make sense that, when every conceivable reform – devolution, centralisation, purchaser-supplier split, inner markets, fundholders, commissioners – has been tried and seen to fail, somebody must challenge the really idea of a central service. It might be worth searching at how other people do it, and not smugly concluding that the public likes the NHS the way it is.

The well being services is not useless or uncaring or that undesirable at generating people far better. It is just also big. Aneurin Bevan was wrong to nationalise it back in 1948 – and his excellent foe, Herbert Morrison, was appropriate in wanting a new service based mostly on charitable and municipal hospitals, as remains the situation virtually all over the place in the world.

Bevan mentioned he desired “a maximum of decentralisation to neighborhood bodies and a minimal of itemised central approval”. No government ever achieves that. Nationalisation led inevitably to the pricey shambles of Tony Blair and Gordon Brown and to a £12bn IT program that by no means worked.

Men and women, particularly the bad, obviously need support with their healthcare. The wealthy are voting with their feet and going personal. But there is no reason why Britain could not go the route of other European countries, with overall health cover becoming a national obligation but with the services presented at the neighborhood, charitable or private degree. What has failed is not care as such but the attempt to regulate, fund and administer what was when a single of the world’s most extravagant industries, overall health, from that apogee of inefficiency: a Whitehall division.

Caring for a human entire body is a individual, intimate issue. It is like teaching and policing, an in essence regional services. Centralise it and turn it into a transaction and its incentives get distorted. Care comes to depend on targets, contracts and a futile struggle against “postcode lotteries”. EF Schumacher was appropriate. Small is gorgeous. The NHS wants to be broken up and returned to surgeries and local hospitals, postcode lottery and all. As the Danes have shown, only a little number of hospital specialisms need to have national interest.

No big nationalised business dismantles itself, particularly one now investing a staggering £15bn on administration alone. People that try out, such as British Rail and nuclear energy, see governments reinventing them in other varieties. As lengthy as shrouds and bleeding stumps are waved more than the Commons, ministers will sense that “anything need to be accomplished” and intervene. It does not work. Denationalisation is now the only model of a public wellness service not tried.

Small is best. The NHS demands to be broken up | Simon Jenkins

Simon Stevens calls for finish to "cookie cutter" method to NHS reforms

Simon Stevens informed MPs that by worldwide standards, England currently has a centralised hospital method. Photograph: Owen Humphreys/PA

In his 1st physical appearance at the well being pick committee, NHS England chief executive Simon Stevens exposed important departures from orthodox thinking about the potential of the overall health support, even though repeatedly championing neighborhood autonomy in choosing the very best way to provide care.

Throughout far more than two hrs of questioning, Stevens exposed deep scepticism about the effectiveness of integration schemes being planned as component of the Much better Care Fund. He highlighted research published final month by York University, which discovered that not one of 38 integration schemes in eight nations – including 13 tasks in England – secured a sustained, prolonged-term reduction in hospital admissions.

As Stevens informed MPs: “There are all types of techniques of undertaking these factors which do not function.”

He believes integration schemes are trying to plug gaps in standard providers rather than make very good solutions function collectively far more successfully. Much better Care Fund ideas can expect extreme scrutiny from NHS England to test whether their assumptions are credible and no matter whether regional hospitals have been closely concerned in drawing them up. With Basis Trust Network analysis revealing that just two% of hospitals truly feel entirely involved, a lot of ideas are likely to be found wanting.

But his most revealing feedback have been on his expectations for the potential of regional hospitals. He supported clinically led reforms such as centralising stroke services and NHS England’s urgent and emergency care technique constructed all around professional centres for existence-threatening and severe circumstances. Nonetheless, in a striking departure from the centralising creed of his predecessor, Sir David Nicholson, Stevens stressed that by global requirements England previously has a centralised hospital method, and dismissed the idea that several nearby hospitals would need to have to disappear.

He said: “It may well be that if we get truly inventive about what it would get to sustain neighborhood hospitals, it might not all often be a query of merging or closing in the way that some appear to consider.”

Taken with each other with his remarks to the committee about searching at new ways of delivering major care solutions, and the encouragement he gave in his first speech as chief executive to suppliers and commissioners searching at new care designs, the invitation is there to hospitals struggling to find a part and a safe fiscal future to propose radical choices to their recent operations.

In some approaches this touches on similar ground to suggestions from the shadow health secretary, Andy Burnham, about district hospitals getting to be care hubs that include social solutions.

Stevens’s hints about the long term of regional hospitals chimed with his repeated endorsement of nearby innovation and autonomy, whilst dismissing what he described as the centralist “cookie cutter” method to reform.

There was much for clinical commissioning groups to celebrate in Stevens’ feedback. As nicely as his help for neighborhood diversity he backed a significantly bigger function for CCGs in establishing main care, in contrast to the existing setup of NHS England’s 27 area teams leading on main care commissioning, he highlighted the value of neighborhood funding answers this kind of as capitation payments.

In even more proof of the critical eye he is bringing to NHS England’s centralising tendencies, he broadly accepted that as well many companies are now being commissioned by his organisation beneath the banner of expert services – expanded from an original £8bn to £12bn and overspent by all around £400m in 2013-14. CCGs can anticipate some of these to be returned to neighborhood management.

So what about the NHS spending budget? By highlighting the a lot reduce growth in GP numbers in contrast with hospital medical professionals it is clear exactly where he sees the strongest situation for investment. In terms of the complete pot, he has promised to reveal inside a 180 days where demand for solutions and present funding will take the NHS more than the subsequent parliament, how significantly the NHS is on program to do to bridge the gap, and what needs to come about next.

Are you a member of our online neighborhood? Join the Healthcare Professionals Network to acquire regular emails and unique delivers.

Simon Stevens calls for finish to "cookie cutter" method to NHS reforms

Simon Stevens sets out vision for radical NHS change and innovation

Practice nurse Lesley Dobson requires Simon Stevens’ blood stress at Consett Health care Centre in County Durham. Photograph: Owen Humphreys/PA

In his 1st speech as NHS England chief executive, Simon Stevens ready the ground for radical adjust in the way health services workers think and operate.

Speaking at Shotley Bridge hospital in County Durham, exactly where he began his NHS occupation as a trainee manager 26 many years ago, Stevens encouraged employees to “consider like a patient, act like a taxpayer” as he gave the first indications of what he would – and would not – be carrying out.

He will not be getting into a trial of strength with the wellness secretary, Jeremy Hunt. He stressed the need for the nationwide leadership of the NHS to operate “in coherent and purposeful partnership”, and in highlighting that the NHS England board is operationally independent, he implicitly recognised the legitimacy of political influence on its objectives. He and Hunt are also politically astute to fall out.

He also manufactured clear that he would not be debating how many clinical commissioning groups there must be his only interest is in producing clinical commissioning work.

There have been robust themes in his speech of breaking down barriers and driving innovation from each inside and outdoors the NHS.

Having broad expertise of healthcare systems around the globe, Stevens is not going to let his vision for the NHS be constrained by traditions of structure or expert demarcation. This contains the rigid demarcations in between professional and acute solutions, primary and community these NHS silos appear a lot less wise from abroad.

He welcomes new providers who will drive change and test new designs of care, and needs NHS jobs to fit the requirements of patients within and outside hospitals, rather than the existing preference for generating patients stick to inflexible care pathways constructed all around outdated occupation structures.

That puts pay and coaching – including the new GP contract – near the top of his priorities.

He sees an urgent need to have for transformational adjust in out-of-hospital care. He can be anticipated to urge CCGs to be adventurous in testing new techniques of delivering solutions, whilst giving them a bigger position in the commissioning of major care. NHS England, which controls 35,000 principal care contracts, has proved incapable of developing powerful neighborhood main care strategies, which is a main impediment to shifting care out of hospitals.

Stevens’ technique to integrating well being and social care is each pragmatic and radical he gave robust hints that he has minor interest in grand schemes for what he described as “combining two financially leaky buckets”, whilst currently being established that the NHS and nearby government should collaborate on new models of care delivery within current structures. Once again, he highlighted the importance of making an attempt suggestions from abroad.

His determination to challenge conventional methods of functioning will be liberating for several employees, whilst presenting a dilemma for organisations such as the BMA.

While several in the well being services believe they can frighten government into escalating NHS paying, a glance by way of the Office for Spending budget Responsibility’s analysis of this month’s budget reveals that a a lot more practical query is when is the NHS going to shed its funding ringfence. Arguably the creation of the £3.8bn Greater Care Fund for integrating well being and social care currently marks the end of that protection.

So some thing has to give. Redesigning jobs and designing shell out structures that drive the correct behaviours and efficiencies has to be the way forward. Unions need to have to be open-minded or risk exacerbating an presently dire economic prognosis, with far worse consequences for NHS personnel.

The other portion of making NHS cash drive adjust is reforming the payment-by-outcomes method to shift care out of hospitals. In a culture of demanding classic demarcations, experiments in vertical integration and clinical staff routinely moving between hospitals and communities during their doing work day should be portion of that potential.

In his first speech, Stevens has presently established himself as a radical. He is starting to describe a more networked, more free of charge-flowing overall health service that is thrilled by clinically led adjust, searches for innovation and will take a lot more dangers.

Join the Guardian Healthcare Experts Network to get normal emails and unique provides.

Simon Stevens sets out vision for radical NHS change and innovation

NHS boss Simon Stevens to give up Leeds for London

NHS boss Simon Stevens (above) has provided assurances he will attend weekly meetings with wellness secretary, Jeremy Hunt Photograph: Linda Nylind for the Guardian

The NHS’s new boss ideas to base himself in London, rather than at the organisation’s headquarters in Leeds, to give himself regular access to ministers and important nationwide wellness bodies.

Simon Stevens, who commences as chief executive of NHS England on Tuesday, intends to commit far more time in the capital than his predecessor, Sir David Nicholson.

Stevens was an adviser on health policy to Labour overall health secretaries Frank Dobson and Alan Milburn amongst 1997 and 2001, then moved to Downing Street to function with Tony Blair but left in 2004 when he joined UnitedHealth, a huge private overall health firm in the US.

Despite his background in Labour politics – Stevens was after a nearby councillor in Lambeth, south London – he was observed by David Cameron as the outstanding candidate to replace Nicholson. Jeremy Hunt, the wellness secretary, ratified his appointment, but only soon after he received assurances that Stevens would attend Monday midday briefings in London at which Hunt meets senior NHS staff.

Constructing perform is beneath way at Skipton Property, 1 of NHS England’s two bases in London, to create offices for Stevens and some of the £95.6bn organisation’s nationwide directors, like Professor Sir Bruce Keogh, its national medical director. Stevens, though, will still spend time in Leeds, exactly where many of the 6,000 administrative workers are based.

The organisation’s media crew, primarily based in Leeds, are also due to move to London, exactly where it only has a modest number of press officers regardless of the concentration of media in the capital.

NHS England was produced on one April last 12 months under the coalition’s NHS reorganisation as a supposedly independent body in charge of the day-to-day operating of the health support. Stevens is keen for it to increase its picture and make a lot more of a mark nationally.

At the Commissioning Live occasion this week, Nicholson explained the organisation deserved just “5 out of ten” for its very first-yr overall performance, and that commissioning of well being solutions, its key function, had been a particular weakness.

Stevens’ arrival has currently led to some modifications at the best of NHS England. Bill McCarthy, its policy director, and Jo-Anne Wass, the director of human sources, are leaving. Karen Wheeler, a senior Department of Wellness civil servant, is joining as its director for transformation and corporate operations. Other departures and arrivals are very likely.

Stevens is preparing to make his initial public statement in the course of a check out to an NHS facility in the north-east on Tuesday.

His ideas to attend the regular Monday meetings with Hunt contrast with Nicholson, who attended the initial couple of sessions when Hunt instituted them in autumn 2012, but then shunned them.

It is understood that Hunt sought, and obtained, assurances from Stevens that he would regularly attend what the DoH calls its NHS delivery meeting, before ratifying his appointment.

An NHS England spokeswoman mentioned: “Simon Stevens has not but taken up post as NHS England chief executive but he hopes to work with all NHS England’s essential partners, such as of course health ministers and parliament.”

Jeremy Taylor, chief executive of National Voices, an umbrella group representing scores of well being charities, mentioned Stevens needed to use his position to oversee a major enhance to the availability of non-hospital-primarily based health services.

“The greatest challenge dealing with wellness and social care is to generate a 24/seven out-of-hospital services that supports the growing amount of men and women with chronic health problems, frailty and disability to dwell as well as achievable. We all know this, and everybody has been saying it for years, but we haven’t noticed a concerted drive to make it take place”, Taylor said.

NHS boss Simon Stevens to give up Leeds for London

Can Simon Stevens save the NHS? A GP"s perspective

Has primary care has located a champion in Simon Stevens? Photograph: Linda Nylind for the Guardian

“Will he, won’t he?” ponder NHS pundits plucking the petals of the privatisation daisy, as they consider the position of Simon Stevens, the incoming chief executive of NHS England, outgoing president of the global overall health division of the American United Well being Group and former wellness adviser to Tony Blair.

In the red corner, “quit privatisation of the NHS” is shouted by hospital consultants on the moonlight run to their personal clinics, shop stewards fearing redundancies for their members, and a crew of managers who suspect the new boss would demand productivity for their £100,000 plus salaries.

In the blue corner, personal bidders and hopefuls of all sorts vying for a seat at Stevens’ table.

Watching the kerfuffle from the gallery are individuals who know that the bulk of the NHS is already firmly in private hands.

Back in 2005, then wellness minister Lord Hutton explained: “90% of all patient journeys begin and end in our main care method with our family GPs. They are all privately run organizations. They are tiny organizations and individuals GPs – fairly rightly so – make a profit from their work with the NHS.”

The fact is that primary care – the portion of the NHS that most folks have contact with most of the time – is already in private sector hands.

Personal businesses are offering everything from maternity to end-of-daily life care. Ambulance contracts are up for grabs and entire NHS hospitals are becoming turned more than to private firms.

Alternatively of debating the tangential issue of privatisation, folks must ask: is Simon Stevens capable of delivering a high quality wellness service? I feel he is. He knows that the NHS was built to supply a initial class healthcare method for all, not to safeguard employment for managers, medical professionals and nurses.

He also realises that the NHS has never been a nationalised business and neither can it survive in its existing state – not with a quick developing multi-million pound deficit.

The private sector isn’t the ideal medicine for the NHS, but it is an inexorable part of the remedy. Nevertheless, independent providers solely motivated by profit will be disappointed. Stevens has won the best job simply because he is very best outfitted to weed out the undesirable or disreputable traders of healthcare.

His earlier job in hospitals taught him there are two varieties of independent provider. People with an unquenchable thirst for profit and these who do not let market interactions to erode moral values.

A harmonious partnership also calls for some brain energy on the part of commissioners, and who far better to fulfil this function than Stevens? His ten many years on the board of United Wellness, which spends $ 150bn purchasing healthcare for its members, has produced him an accomplished commissioner.

I have no doubt that he will lead from the front and that his prime priority will be to disseminate his knowledge and knowledge to all commissioners, not just clinical commissioning groups.

I think he will create a commissioning model that is not limited to public and private sectors but also consists of the community and voluntary sectors, the values of which he learned as a councillor in south London.

He will, thanks to the Well being and Social Care Act, ensure the voice of the voluntary sector is heard by the health and wellbeing boards. Bed-blocking alone charges the NHS about £200m a 12 months and it transpires when assistance from social care is not accessible in the community for vulnerable individuals.

The important problem for boards is how to get care in the property appropriate and how to utilise large third-sector organisations as well as the GP primarily based army of volunteers – the patient participation groups.

I am convinced that Stevens has a great opportunity of delivering a leading-top quality, minimal-price health support and, as a GP and CCG commissioner, I am delighted that principal care has identified a champion at the head of NHS England.

Dr Kosta Manis is cardiology lead for Bexley clinical commissioning group

Join the Healthcare Professionals Network to get normal emails and exclusive provides.

Can Simon Stevens save the NHS? A GP"s perspective