The clear strategic path that the NHS England chief executive is mapping out for future challenges and opportunities is reassuring

The NHS faces the biggest range of opportunities and challenges for a generation: rapidly growing demand and the biggest financial squeeze ever, juxtaposed with technological and medical advances that can transform healthcare and enable patients to manage their own health and wellbeing.

‘Simon Stevens has the freedom to think and act on his own terms as he sees and finds the NHS today’

It is reassuring that NHS England’s chief executive Simon Stevens is beginning to map out a clear strategic path to navigate through this tricky and complex landscape.

Helpfully, he is not tied to existing thinking, does not need to justify what he has inherited, and has the freedom to think and act on his own terms as he sees and finds the NHS today. 

Judging by last week’s interviews and his early speeches, he is using that freedom to stimulate fresh thinking and optimism for a sustainable NHS in a way that resonates with Foundation Trust Network members.

The need for change

At the heart of this thinking is the need for radical and extensive change if the NHS is to remain clinically and financially sustainable.

In Mr Stevens’ words: “We’re not just in the business of performance, we’re in the business of change.

“It’s not just funding that will shape the future success of the NHS. As important will be our capacity for improvement and change.”

‘Local health leaders must come together to drive both clinical and organisational change, but within a single NHS framework’

His understanding that driving this change depends on the relationship between the NHS system and leaders delivering healthcare locally is welcome.

We have, at various times over the last decade, veered between top-down centralism and a view that, in a market, it is entirely up to local heath and social economies.

It clearly must be local health leaders who come together to drive both clinical and organisational change. But this has to be done within a single NHS strategic framework.

A framework that sets the general direction of travel and clearly defines the limited role of the centre, including how it will support and enable local health and social care economies to deliver the changes their communities require.

NHS England needs to work with the rest of the system to create this framework and, once it is been completed, support local health and social care economies to plan effectively and sustainably for the long term within it.

Meeting local needs

Mr Stevens also strongly endorses our members’ view that this approach must allow greater variation than we currently see in the NHS – as much variation as the heterogeneity of local health needs requires.

He says the “N” in NHS does not need to stand for uniformity in administrative arrangements. Early provider pioneers like Chelsea and Westminster Hospital, Northumbria Healthcare and Yeovil District Hospital foundation trusts are finding that they cannot deliver effective integrated care models within existing structures.

‘Stevens has brought a fresh dose of realism to the task of NHS England as an excellent commissioner’

For example, moving to accountable care type organisations requires commissioning and provision within a single organisational form – something that Mr Stevens rightly welcomes, if that is what local communities need.

He also recognises that in some areas it will be providers that lead change, while in others commissioners will lead.

We also welcome the clarity he has brought to the role and purpose of NHS England as an excellent commissioner, focusing on its national commissioning role and supporting and overseeing local commissioning.

So far he has brought a fresh dose of realism to this task; pointing out that clinical commissioning groups and health and wellbeing boards still to have to prove themselves, and that NHS England needs to exercise its specialist commissioning and CCG oversight responsibilities more effectively.

Carefully recognising success

Tone and approach also feel important. It would have been easy to use a somewhat impatient, pessimistic and critical tone.

Instead, he has been careful to recognise the success of what has been achieved and to reach balanced, optimistic, judgements like “the NHS has done incredibly well during this five-year period of austerity in that it has maintained fundamental performance standards” while also rigorously pointing to where improvements are needed.

There is also much to welcome in his focus on the need for more radical approaches to workforce, the NHS’s significant failures on race equality, and how the NHS has an important role to play in the wider economy.

Remaining questions

We should not be too misty eyed at this point as there is much still to do.

‘The early foundations feel solid and capable of being developed into the strategic vision the NHS so desperately needs’

How does a commissioning focused NHS England fit into the wider NHS system leadership? What should the NHS do to ensure local leaders have the capability and capacity to drive the changes that are required?

How do we manage the financial squeeze? How, for example, would a transformation fund actually work in practice?

But the early foundations feel very solid and capable of being developed into the full, sustainable, deliverable, strategic vision that the NHS so desperately needs at this point.

Chris Hopson is the chief executive of the Foundation Trust Network