Simon Stevens favours a ‘mixed model’ of health economy accountability in which some clinical commissioning groups could delegate responsibilities to local authorities or providers of new care models, he has told HSJ.
During an exclusive interview, HSJ asked the NHS England chief executive about proposals by Labour and the Liberal Democrats to substantially shift responsibility and budgets from CCGs to health and wellbeing boards, which are committees of local authorities.
Mr Stevens stressed the NHS should not be “distracted by” organisational questions, but explained he favoured a “mixed model” instead of any one organisation type being in charge.
His approach meant that in “some places” where “you’ve got very effective CCGs either individually or together… driving effective change”, they should be backed as health economy leaders. Elsewhere, where “local government [has] been very effective at driving change… I would expect the health service would work much more closely perhaps under the leadership of the combined HWB”.
Mr Stevens continued: “In other places it may well be that the devolved [capitation] budgets to the new care models will be where a lot of the action is occurring. So we make a mistake when we put all our eggs in one basket.”
More from the Simon Stevens interview
HSJ pressed him on whether accountability for the NHS budget could be held by different organisations in different areas - for example, if a CCG wanted to pass all its responsibilities to a foundation trust or council.
Mr Stevens said that while “legally speaking as the statute stands” an area had to be covered by a CCG, so it could not be scrapped altogether, it could delegate its responsibility to another organisation. If an area “can make a proposition that [this would] overcome obstacles to change, for turbocharged improvement, then let’s go for it,” he added.
Meanwhile, Mr Stevens said that, notwithstanding the possibility of a weak minority or coalition government after the May general election, the health service was well placed to press ahead with the reforms outlined in the NHS Five Year Forward View.
“I think the health service is, in some ways, in one of the best positions it’s ever been in at this point, going into an election, because I do think collectively we have a game plan, a shared sense of direction, and it’s time for us to seize the moment,” he said.
“We don’t have to sit back and wait for the perturbations that might emerge; we know what we need to do, we need to step up and do it.”
Mr Stevens added: “We, as the NHS, have been very clear to all the parties that what we are not looking for is a new top-down reorganisation, and they have each said that they accept that point, including interviews that party leaders have given to HSJ, so we need to hold them to that commitment, and get on with the much more fundamental reshaping of care and services which… everybody is signed up to.”
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