• Stevens: “It is a matter of fact that most management in the NHS is already done by clinicians”
  • “I very strongly think it would be a mistake to try and mandate one single solution to social care integration across England”
  • Contracting “is in a much better place” than previously but “is still going to be really difficult”

NHS England chief executive Simon Steven’s take on whether introducing general management in the NHS was an “historic mistake”; progress on the 2017-19 contracting timetable; and the latest prospects for social care service reform.

On NHS management

HSJ asked Mr Stevens about whether introducing general management to the NHS was an “historic mistake”, as Jeremy Hunt said last week

Simon Stevens: “If we wind the clock back to the mid-80s, the reality is that so called ‘consensus management’ in hospitals had its own defects.

“So therefore it was right to think about how do you actually bring operational management to a more sophisticated level inside hospitals in particular, but not just hospitals.

“Secondly, it is a matter of fact that most management in the NHS is already done by clinicians. In primary care it is GPs who lead their practices, in hospitals I would argue that that bulk of management is done by ward sisters and charge nurses.

“Within the medical specialties it is clinical directors in most hospitals. So I think the debate was a debate about chief executives.

“Really, I think what we want is to be able to draw chief executives from the ranks of seasoned operational NHS managers, and clinical managers both, and is clearly the right answer here.

“That’s the approach I’ve been taking in building the leadership bench at NHS England, appointing [specialised commissioning director and doctor] Jonathan Fielden, [director of primary care] Arvind Madan, a jobbing GP; Clare Murdoch, one of the best mental health chief execs, who also happens to be a nurse; Cally Palmer [also a nurse], leading our cancer work.”

On social care funding

How much progress can you make within the funding and existing system to make social care sustainable, and have you found an answer, for example in the “enhanced health in care homes” vanguards, or Salford Royal Foundation Trust’s taking on social care responsibilities?

“The first point to make is that – and it relates to the local dynamic with councils through the STP process as well – the NHS’s budget settlement in the spending review was not intended to, and obviously cannot absorb, all the pressures in the local authorities [and the] financial pressures on their side.

“That fact should not be used as a reason for individual councillors or NHS bodies taking issue with the broad direction being set out in the STP. Point one.

“Point two: I think there are examples round the country where despite that fact people have actually – you talk about Oxfordshire, the action there that has reduced delayed discharges up at [John Radcliffe hospital] is quite impressive.

“But what we can’t do, I don’t think across the country as a whole, which would be another sort of backdoor funding pressure on the NHS, is begin to employ at Agenda for Change rates, staff who properly are social care staff.

“But there will be places where people can work out the sweet spot. Tameside I think are doing something similar.

“So my point of view is we would be wrong to mandate a national answer, which is to say the answer is Oxfordshire, or Tameside. These are decisions that need to be made between consenting adults – local authorities and the NHS leaders locally, informed consent.

“I very strongly think it would be a mistake to try and mandate one single solution across England.”

On the contracting round

Mr Stevens commented on progress on agreeing operational contracts for 2017-19 by 23 December

“First up – I think we should remember that we’re in a much better place this year than where we’ve been in previous years.

“Despite the naysayers, we were able to bring forward the timetable for producing the tariff, the standard contract, the CQUINs, taking the kind of fining issue off the table. All of that. It’s never been done…

“Secondly, the reality is there have been some parts of the country where some of the legacy behaviours – there’s been a bit of that – lowball offer, inflated counter-offer, that sort of yo-yoing.

“But I think the message is beginning to sink in that time does not permit and we don’t want to create time for months of that kind of pissing about.

“The third thing I would say is that even with the best will in the world it is still going to be really difficult.

“There are going to be some very complex trade offs to make given we’ve got to reverse engineer from the money we’ve got in each place for 2017-18/2018-19 back to a set of decisions about where the money goes.

“We want people to take seriously the 23 December deadline. There’s going to be no meaningful new information people are going to have on 15 January that they don’t have on 22 December.”

Exclusive: Some STPs are becoming 'integrated organisations', says Stevens