The Chief Executive of our Health Service is a quiet but radical reformerby John McTernan / March 29, 2016 / Leave a comment
Read more: A sugar tax does not go far enough
Is leadership about forcing people to do your will or is it about persuading and inspiring them? It may seem a crude dichotomy but both modes of leadership are currently on display in the National Health Service (NHS). The Health Secretary Jeremy Hunt is engaged in a bitter and divisive struggle with the doctors’ union, the BMA, over junior doctors’ contracts. Meanwhile, the NHS England Chief Executive Simon Stevens is leading the most radical reshaping of the health service since its foundation—without enforced organisational change.
Each model of bringing about change has been highlighted in the last few weeks. On the one hand, the BMA responded to Jeremy Hunt’s threat to impose the new junior doctors’ contract by calling an all-out strike—the first in the history of the NHS. On the other, the Government announced a “sugar tax” in the Budget.
Much ink will be spilt on the junior doctors’ dispute between now and the inevitable deal but the more fascinating subject is the quiet revolution symbolised by the “sugar tax”. Stevens has been a strong advocate of this, having earlier this year proposed a 20 per cent “tax” on sugary drinks in NHS facilities in England. This would have raised a projected £20-30m a year by 2020, but more importantly it was intended to change behaviour. It has now been superseded by George Osborne’s Budget announcement. The details of the “sugar tax” can be mocked. Why are sugary yoghurt drinks excluded? Why, indeed, is sugar itself exempt? The point of maximum controversy occurs at the actual announcement—Gordon Brown prepared for one in 2009 but backed off at the last moment—but that has passed quickly for Osborne and its impact will grow over time.
To see what should happen just look at salt in food. Over the last decade or so the Food Standards Agency estimates that over 11m kilograms of salt have been taken out of our food. The result? A 15 per cent fall in average salt intake and 40,000 fewer strokes and heart attacks. Longer, healthier lives and fewer demands on the NHS. This is the model for the NHS Stevens is promoting as Chief Executive. As he puts it: “The NHS is a social movement and not just a health care service.”
Sometimes the most radical thoughts are the simplest—once you reconceive the NHS this way it becomes easier for everyone to take control of their own health. “I am not just doing this for myself because it makes me fitter not fatter, I am doing it for others because I am freeing up resources for those who need them more.”
It is no coincidence that the NHS smartphone app “Couch to 5k” has become so popular at the same time as “Parkrun”—a group run of 5km held weekly at hundreds of sites across the country—has expanded across the country. Exercising on your own complements exercising with others.
We will see more of this as Stevens leads the NHS into new places. He has a passion about housing so is pioneering work “with ten housing developments to shape the health of communities, and to rethink how health and care services can be delivered.” In other areas the new powers devolved to local governments and Mayors will be harnessed to improve health.
The key to this is agency—giving individuals the support they need to take the control they can and should have over their own lives. The purpose of the NHS should not be the treatment of illness, but the promotion of health.
Now read: Duel: Should we have a sugar tax?