NHS chief has common sense on his side on seven-day working
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Version 0 of 1. The annual NHS Expo is an odd affair. It’s part annual conference, part trade show, part good excuse for several thousand senior staff to spend two days in Manchester. NHS England certainly doesn’t see it as an opportunity to generate huge media interest in their work, except through its chief executive, Simon Stevens’s big speech. So it was all the curiouser to find the man Health Service Journal dubbed the service’s messiah delivering said setpiece from a smaller stage, rather than in the main hall. Result: it was packed, forcing the many, many people who couldn’t get in to peer through a door, or watch it on a screen on one of the stands instead. Which is a shame, as – in his typically diplomatic, read between the lines, non-shouty sort of way – Stevens had a lot of interesting stuff to say. His dig at the “right old alphabet soup” of out-of-hours medical services, which often baffles those who fall ill, then made headlines. But some of his less quotable thoughts may prove more significant in the long run. First, the extra £8bn for the NHS set out in the Five Year Forward View last October: Stevens dropped in (almost as an aside) a reminder that that sum – which, the health secretary, Jeremy Hunt, insists is all that’s on offer – always depended on social care being sorted out and progress being made to tackling the causes of so much ill-health. Given that social care services are set to be cut even further due to continuing Whitehall austerity, thus increasing demand for NHS care, and that almost no meaningful progress has been made in tackling public health problems, especially our calamitously dysfunctional relationship with food, the NHS will clearly need more than £8bn. Hunt, who in June publicly told the NHS to stop debating how much extra dosh it needed and start making its promised £22bn of efficiencies, is unlikely to be amused. Related: Is Jeremy Hunt's vision for the NHS already mired in difficulty? Second, seven-day services – the government’s main priority for the NHS in this parliament: on that Stevens was also interestingly unaligned with Hunt. The health secretary has threatened to force hospital consultants to routinely work at weekends if they don’t accept it. (His deadline to the British Medical Association expires on Friday). But the NHS’s chief executive pointed out that many consultants already do work overnight and at weekends: exactly the point of angry doctors’ #ImInWorkJeremy campaign in July. And in any case, “we don’t need every consultant in every speciality to provide planned care on a Sunday,” Stevens said. As with the £8bn, Stevens has reality and common sense on his side. The Q&A after the speech also brought Stevens’s observation that the drive to fulfil the government’s pledge of a truly seven-day NHS by 2020 means “there needs to be a hard look at the way we organise services”. It is an open secret that the Forward View and political imperative to expand patient access to services at weekends will inescapably mean some reconfiguration of which hospitals do what. He cited the recent agreement in Greater Manchester between its 12 clinical commissioning groups and 15 different providers of care to designate four of its hospitals as super-hospitals as “precisely the kind of approach we need more generally”. But as this centralisation of services unfolds and local resistance emerges, the government is likely to be confronted with an array of Kidderminster-style situations, fraught with political risk. Hunt says he backs the Forward View unequivocally. Will he still when protests begin against an A&E or maternity unit being downgraded or even closed? As recently as April, remember, Hunt stressed that “smaller local hospitals have a vital role to play in the future of our NHS” when rejecting plans for centralising Epsom and St Helier hospitals in Surrey into a single 800-bed site. Already in Manchester, a row is brewing over Wythenshawe hospital losing its emergency surgery services because it didn’t get super-hospital status. Consultants there fear that will lead to a “domino effect” loss of other services. They are threatening a judicial review of the Healthier Together consultation process that left them a loser. Reconfiguration, which guarantees political heat, will test Hunt’s backing for Stevens’s blueprint for a new NHS, possibly to destruction. |