Stevens: NHS must act to prevent 'hollowing out' of DGHs

Giving a lecture at the Royal Society of Medicine, the NHS England chief executive said the NHS would increasingly have to consider the economic impact of service change alongside any clinical case for reconfiguration.

Mr Stevens’ wide-ranging lecture also addressed the need for the NHS to make sure nurses and doctors worked in the areas they trained, and for the service to start measuring “population health risk”.

The NHS England chief highlighted how the NHS had become the “anchor institution” in communities which had seen dramatic economic decline.

However, he told the RSM: “In many of these communities there is a sense that these [NHS] services are at risk of being eroded.”

This, he said, had been driven by the “concentration of certain capital-intensive equipment [in specialist centres] and, at the same time, the digitisation of interactions which are hollowing out what used to be the general hospital model”.

Mr Stevens claimed the concern this trend created “shows up as protests, political activity and a sense of the tide going out from these communities”.

He concluded: “I don’t think we should ignore those views and one of the things the health service has got to get right over the next five to 10 years is not only thinking about the clinical case for change – which may be strong in services such as stroke and major trauma – but [getting] more creative about what are the models that will help us sustain these services in communities where their absence would produce [adverse] second and third order effects in terms of economic impact and social cohesion.”

Turning specifically to the NHS’ role as an employer, he said: “We cannot have a situation where, in the nation’s most trusted public service, communities are told the reason that your hospital is not viable or it is difficult to see a GP is because we can’t get people to come and work here.”

Part of tackling this challenge, he said, was making sure that nurses and doctors who trained in new medical and nursing schools did not leave the area.

Speaking of the new medical school in Lincoln, Mr Stevens said: “If that medical school and their equivalents are not producing young doctors who want to work in East Midlands and Lincolnshire, then we will have failed in choosing those as locations to expand this educational opportunity.”

Reflecting on the burden the wider social determinants of health, such as obesity and smoking, place on both the NHS and these at-risk communities, Mr Stevens argued it was necessary to change how policy decisions were made.

“It is time to stop just tracking the flow of healthcare consumption through the national health service”, he said, “and instead start measuring the stock of population health risk. Because that is effectively the future cost that will be headed our way – and what we don’t do is to track the extent to which that balance sheet of health risk and cost is moving in a positive or a negative direction in a way I think would focus minds and help make the right economic trade-offs in public policy.”

In the next few days, HSJ will run full edited highlights of Mr Stevens’ lecture in which he also set out the need to reinvest in reablement services; revealed an attention to be more “ambitious” in the NHS’ role in tackling air pollution and climate change; and cautioned the legislation of medicinal cannabis could be exploited for commercial gain.