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Stevens wants hospital plans to be local, but not too local

Michael White
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The NHS England chief executive has been busy the past few weeks giving big speeches and interviews about new models of healthcare, but Fleet Street isn’t paying much attention

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If you weren’t expecting much on the healthcare front from the new Queen’s Speech programme, you won’t have been disappointed.

But don’t despair, modern politicians too often mistake legislation for constructive activity – former health secretary Andrew Lansley’s bumper reform bill was a case in point - so Jeremy Hunt’s preference for a quieter life may be both wise and shrewd in the election run-up.

Plenty of grief to go around

The health secretary will face enough grief without looking for more, as I was reminded this week when I foolishly engaged on Twitter with some well intentioned defenders of the NHS.

They believe passionately that a Tory “privatisation” plot is destroying the service, which simply needs more staff and money.

‘The health secretary will face enough grief without looking for more’

One of them – who should know better – drew my attention to a 2011 ‘Oliver Twist’ article by King’s Fund health economist John Appleby, which rested on a comforting expert prediction that the UK economy would grow by 14% in real terms by 2015.

Alas, it didn’t and it won’t.

Stevens is not the Messiah

The Financial Times this week splashed an analysis suggesting there was still fivefold variations in the costs that different hospitals book for identical procedures.

I know it’s tricky, but the Financial Times is not the Daily Mail. Nor is it much read by Twitter types.

Despite being the new man in charge of NHS England, Simon Stevens – ‘he’s not the Messiah’ – rarely gets a name check from such online activists either, apart from occasionally being labelled as part of the Tory privatisation plot.

‘I hope Stevens is grateful for Fleet Street’s lack of attention, though it may just be the honeymoon phase’

In view of the way Sir David Nicholson was hounded out of the job, I hope he’s grateful for Fleet Street’s lack of attention, though it may just be the honeymoon phase.

Yet Mr Stevens has been busy: a big speech on Wednesday at the NHS Confederation conference after two last week, an interview with The Daily Telegraph which briefly got the BBC excited, but generated few column inches elsewhere, apart from the bit about the need to cherish small local hospitals more than we have done.

New experiments

Experimenting with new models of healthcare around such hospitals – rooted in the community, drawing on volunteers and patient insights – will help provide better care for the elderly – “the single most important question facing us”.

He’s been telling NHS managers at the King’s Fund and clinical commissioner conferences too.

Newspapers are always keen to predict that a speech by X will put him on a collision course with Y. But don’t believe it. Elected politicians love words like “local decision taking” – at least in theory and in their own patch – and even Ukip leader Nigel Farage’s nostalgic heart would warm to The Telegraph’s picture of a cottage hospital, preferably with roses round the door.

On the same platform, last week Mr Hunt duly applauded Mr Stevens’ out of hospital care commitment. His officials point out he’s never had a national policy on reconfiguration, and would welcome a bigger role for smaller hospitals.

‘Newspapers are always keen to predict that a speech by X will put him on a collision course with Y. But don’t believe it’

So that’s alright then? Is it the end of brutal or careless closures and reconfigurations?

Mr Stevens, who worked in Whitehall for MPs Frank Dobson, Alan Milburn and Tony Blair, is a defter political operator than ex-communist Sir David; a Blair to his Gordon Brown.

In these speeches, he praises managers lavishly – more graduates want to be NHS managers than join the BBC – urging them to promote community, diversity and a listening culture.

He favours “local solutions” in which commissioners involve health and wellbeing boards - Labour’s public health spokeswoman, Luciana Berger, made the same emphasis this week – in stress testing better care fund plans.

But local plans “must be grounded in the context of strategic five-year reviews”, he also told his audiences. So local, but not too local. No hospital is an island entire of itself.

Michael White writes about politics for The Guardian

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