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

The long goodbye

Simon Stevens arrived back in the NHS during 2014 to take charge of the relatively new national commissioner. Over the last five years, he has bent prime ministers to his will, become the de facto health secretary (except when the subject has been technology or patient safety), and – within the last few months – taken on such a dominant role within the NHS bureaucracy that he is now simply referred to as the “Leader”.

But relatively soon the NHS will have to learn to live without him (probably).

HSJ’s editor has set out Mr Stevens’ likely exit strategy, which suggests that summer 2020 will see the departure of the NHS England chief.

Between now and then his to-do list looks fearsome – but luckily most of the challenges play to Mr Stevens’ particular interests and unique skill set.

As for who follows Mr Stevens? One further thing has changed since 2014 – this time there is no obvious candidate. 

The capital problem

The lack of capital investment in NHS mental health services is a well discussed trope. This week HSJ has revealed some of the consequences of neglecting the NHS’s mental health estate.

Data from the Care Quality Commission, revealed for the first time by HSJ, showed around 1,200 mental health beds are still placed within “dormitory-ward” style settings. This means shared rooms, with no en-suite bathroom, and often just a curtain separating the beds.

NHS England appears to have met the calls by trusts, staff and patients to end the use of these wards with a shot, quite fairly, at the government. Essentially this is a capital funding issue and the national commissioner has been pretty clear – the next spending review should see some dedicated capital for mental health.

Stories from the patients who have been forced to sleep on these wards explain the key reason why they should not be in use – they are the exact opposite of a therapeutic environment. Mental health wards should be places in which people, in their most distressed state, go to recover.

However as one woman put it: “I was in total distress, being in a noisy place, where I had no door I could shut to keep noise out and no feeling of safety… One thing I can say is that I’d rather die than go back there.”