The true politician last week was the NHS England chief executive, who deployed his five year forward view and returned to base without a scratch
So, how well did politicians do in responding to the multiple challenges set by Simon Stevens’ NHS Five Year Forward View? It’s a view that is bound to have influence far beyond its formal remit – NHS England – since all four home countries face similar, mostly converging, problems.
‘Simon Stevens held up well, fluent and perky, but also solid as he skipped past the political IEDs’
A score of five out of 10 would be generous, I think, with the exception of the NHS’s chief executive himself, who fared rather better.
“Hang on there, Simon is not a politician,” I hear you cry. If you think that, you have obviously not read his report – just 37 no-frills pages and, hurrah, no staff or patient photos either. It is full of consensual good sense, drafted in sinuous prose that neatly sidesteps or ignores the service’s IEDs.
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In a previous life this man was clearly an army bomb disposal expert. But his CV does tell quite a tale: clever comprehensive school boy from Birmingham, a Balliol College graduate, NHS manager from 1988-97, Labour councillor for Brixton, Whitehall health adviser from 1997-2004, post-Milburn a US health corporate from 2004-13, and now in charge of the £100bn service at the age of 48.
Did he plan it on the back of an envelope? I wouldn’t be surprised. He’s just not a party politician any more.
Despite all those pre-publication leaks, his one day tour of the TV studios helped him stay top of the headlines, beating distractions such as those £55 GP fees for spotting dementia.
‘Stevens was relentlessly upbeat about staff performance and mentioned the “huge sacrifice” on pay’
I thought Stevens held up well, fluent and perky, but also solid as he skipped past the political IEDs. He was pardonably shifty on the scale of private sector involvement, saying “sometimes there will be a case”, and stressing that 94p in every NHS pound is spent on NHS providers (is this still true?).
He was aware of patient alarm and probably wisely vague. After all, John Reid got into trouble for casually citing “15 per cent”.
He was also relentlessly upbeat about staff performance and mentioned the “huge sacrifice” on pay, while passionate on NHS values and recent achievements.
Much of what he is saying is a better-written, ie shorter, version of the Wanless report by Gordon Brown’s tame banker 10 years ago: reduce demand by preventive means, increase efficiency even more, find extra money – nothing “intrinsically undoable”. No need for charges, eh!
Like Wanless, Stevens even has three scenarios. In the best of these we close that £30bn funding black hole. Unlike Wanless, of course, Stevens is in charge, as much as anyone is. Lansley’s law was ignored, a defused roadside bomb.
The “view” - deceptively, it’s only a view - contains a dash of Darzi’s polyclinics in the mix (multispeciality community providers, anyone?), a splash of Kaiser Permanente’s integration model, a dollop of democratic local public health power, the stern hand of central direction tempered by sensible acknowledgement of varying local needs.
‘Hunt liked prevention and efficiency, but not Stevens’ 1.5 per cent begging bowl’
When I got to Mr View’s few crisp sentences on the revolutionary scope of medical tech – and how we keep getting it wrong – I had to dab my eyes.
MPs did less well after Labour’s Andy Burnham forced a Commons statement out of Jeremy Hunt. Hunt liked prevention and efficiency, but not Stevens’ begging bowl of 1.5 per cent on top of the coalition’s annual inflation proofing; he ignored it while appealing for a “more measured debate”.
In turn, Burnham, who is now in post-Miliband leadership campaign mode, ignored that plea, claiming Stevens vindicates his own analysis. Hunt retaliated; both men are partly right. I’d like to say backbenchers were less partisan; alas few were.
What they dare not admit is that the economic squeeze is likely to continue and probably get worse. On that, even Stevens’ perky optimism sounds off key.
Michael White writes about politics for The Guardian.