Conference Report - Simon Stevens' Opening Speech

By Simon Stevens

A simple message – more strength to your elbows. He has run CHs as manager (actually matrons run CHs), and has been battling orthodoxy which for years has said all towns should have large hospitals – how about 10 hospitals for GB? Previous strategies, such as the Hospital Plan for England in the 1960s focused on centralisation. This is no longer the focus. Nye Bevan thought that small hospitals were not so good.

Three reasons why CHs are important. First, CHs are social assets and big national Institutions forget that local hospitals were often set up by local subscription. The NHS is not just a repair organisation, it is a social service. Secondly, CHs are about compassion which is greater in CHs than in DGHs. An article written in 1960 – ‘Are our hospitals lacking humanity?’ Patients exist for hospitals rather than the other way round. Thirdly, the case for CHs is not only based on compassion, fundamentally it is based on how the NHS is to work in future. Centralisation is good for strokes and major surgery which leads to better survival rates. Major trauma centres have saved more than 500 people after major trauma. What is the broader view of what CHs can provide? There will be changes and closures but care closer to where patients live is essential. Chemotherapy, dialysis and OPD services should be more local rather than expecting patients to travel too far, as at Newbury. 

Triple integration will mean acute, community and mental services working together. Urgent and emergency care services must be sorted out with major redesign over the next 3 years – where to go in an emergency. Urgent Care Centres may be based on MIUs, as well as out-of-hours clinics. Maternity is possible in CHs but what should the structure of the service be? Options in non-acute settings need to be beefed up. CHs have helped for over 100 years, and 1/3 of the buildings may be unfit for service in 21c, but stripping of assets is not on the agenda.

Improvement of rehabilitation services is in some way back to the future. Lord Darzi wrote about polyclinics which in many ways are CHs, which must get closer to GPs in each area. GPs have pulled back from CH involvement but they hold much of the funds so to keep the services going they need to be encouraged. 

With the nurse workforce growing older and joining nursing agencies it is understandable that this causes unease because nurse training places dropped after an unfortunate report. Flexibility is more popular so there is a need to clamp down on excessive fees that agencies charge. There is power in people power to keep services open, and people are assets to get redesign under way but this needs active community leadership. Plans to increase AHP and nursing numbers which are multi-disciplinary could help in MIUs – what is the best way of working?

There is a need for nurses to be able to have a full range of training but they need to be compassionate and prepared to do the basics but the pressure is to be graduate. “We are going to do just this. More training and options are needed to improve nursing services.”

There is a disconnect between the level of work and resource allocation in the mental health service, so reorganisation of funding is to be set up. Past years have sucked funds into the acute sector and denuded community services, so acute trusts must be helped to reduce costs (the overspend is £22.5 million).

They must all work together to improve joined up working and procurement. We should move investment into the community and GP services. GPs have 90% contact with 10% of the budget.

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