The must-read stories and debate in health policy and leadership.

In his last interview at an NHS Confederation conference, Sir Simon Stevens gave some advice to his successor, whoever that may turn out to be.

He told him or her to not “be afraid to stand up and speak out for what is right” in any future debates that affect the NHS. It’s not a surprising piece of advice from a man that has been recognised for his political nous throughout his tenure as NHS chief.

But with the new NHS health bill looking to strengthen the powers of the secretary of state and in turn reduce the independence of NHS England, it may well be that it was Sir Simon’s own belief in speaking out, and the political headache that often caused, that might hamper the ability of his successor to do the same.

He also revealed he keeps on his desk a card on which his children wrote out his favourite “mantra”: “Think like a patient, act like a taxpayer”. One wonders if whoever takes his seat next will find that card left for them.

Sir Simon also took the opportunity to lay out what he thinks a comprehensive social care reform plan should look like. Rumours are he has been asked by the government to take on that plan once he steps down as NHS chief in July. He didn’t discuss his next career move in the interview, but it’s clear he has thought through what remit he would expect if he did accept the job.

Death by structure

In what may prove a significant intervention, Dame Gill Morgan has said the new governance structures around statutory integrated care systems may become a “bureaucratic nightmare”.

Dame Gill, previously chief executive of NHS Confederation and chair of NHS Providers, said the “bureaucracy and complexity” surrounding the proposed new white paper is raising concerns among the members of Confed’s ICS network.

Speaking as the first chair of Confed’s new ICS network “advisorate”, she said the layers of governance are “particularly” worrying for larger ICSs.

The comments are reminiscent of a warning from Marcel Levi, who stepped down in the spring as University College London Hospital Foundation Trust chief executive after more than four years to take up a senior role in his home country. He warned that fixating on the bureaucracy of ICSs would cause agile health systems forged during the pandemic to come to a “grinding halt”.

Dame Gill also warned that while the proposed health bill is permissive in its approach to legislation, NHS England’s draft guidance for ICS, due to be released very soon, is in danger of being “overprescribed” and failing to  “recognise… fundamental [size] differences between systems”.

As ICSs wait to see final NHS England guidance on how ICSs and provider collaboratives should operate, it may well be that ICSs begin to question the value of the boards, sub committees and collaboratives that are being generated as the implications of the white paper are understood.

What this means in the long-term for how ICSs will be structured is still unclear, but expect many providers to push back against what Dame Gill describes as an “absolute panoply of meetings” if it prevents them from getting on with the urgent task of tackling waiting lists.

She said ICS leaders want “clarity” about what principles, priorities and outcomes are expected and then to be given “the opportunity to find good local solutions”, adding: “Prescription takes away the opportunity for innovation.”