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Virtuous but not yet


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Friday, 5 June 2015

Virtuous but not yet

Simon Stevens was on messianic form this week. His pronouncements in the wake of the general election are becoming more confident, more assertive. Which is just as well, because the NHS faces challenges of biblical proportions.

The NHS England chief executive’s address to the NHS Confederation came during a week of big announcements:  NICE abandoning its work on safe staffing standards, the removal of two waiting time targets, a renewed drive to improve procurement practices and “concerted” action to reduce spending on agency staff.

The Five Year Forward View has the backing of the government, which has signed up to the Faustian pact to trade £8bn in cash for £22bn in efficiencies. Still no due dates on the credit-line or the repayment schedule, but to be fair, nor is there much detail about the NHS’s side of the bargain either.

No one seems able to say exactly where the line is that separates too little and enough, why £30bn is the right number, or how the books can balance when there is not enough money in primary care, secondary care, social care or mental health.

But these are nit-picking details. It’s not, as Stevens said, “all about the money”.  It’s all about attitude.

A failure regime regards lack of money as a disaster and pulls the duvet over its head, whereas a success regime regards it as a challenge, gets up a bit earlier, has a cold shower and goes for a run.

Which is an opportune moment to mention the fight against obesity, the greatest health problem of our times, according to Mr Stevens. The NHS is tackling the problems posed by booze and fags, he said, but obesity is getting worse. It affects one in ten primary school starters, but one in five leavers.

Health education had little or no effect on smoking. It was only legislation that made a difference. The law changed people’s behaviour, not the other way around. Draconian legislation aimed at the food industry and laws restricting eating do not seem likely. Instead we’ll get more industry dialogue and initiatives, a bit of salt reduction here or signposting there, and a few more fruit and salad options for guilty parents at Macdonalds.

The war on obesity, like the war on terrorism, will be a long and difficult campaign, the work of decades, not of a single political cycle. It is vain to pretend it can be won but foolish not to try.

Even so, and despite the lack of evidence that public health campaigns make any real difference, it is a pointed irony that as Mr Stevens was speaking out about obesity, the Treasury was busy slimming down the public health budget by £200m. These are not the pounds Mr Stevens wants us to shed.

Or perhaps it isn’t an irony. Salvation must be chosen. Unlike reform, it can’t be imposed. Only half of Mr Stevens’ speech was aimed at NHS managers, the other half was aimed at the rest of us. Don’t expect public health budgets or hospitals to get you out of trouble. They may or may not be there.

Of course cynics and old campaigners will view the flurry of post-election business and speechifying as part of a familiar pattern. Sound the alarms, show you mean business, kick a few backsides then watch while everything settles back into the old groove.

That comforting scenario seems unlikely this time. Read Health Policy Insight’s transcript of Stevens’ speech and note how little reference it makes to strategy, structural solutions, innovation or even the “new models of care” the Five Year Forward View is so keen on. Change will not come from “how to do it” documents or “more Powerpoint slide decks”, Stevens said. That was the “David Brent approach”.

Warning his audience not to mistake the Five Year Forward View for “a fantasy of someone buying us a few more years of the status quo”, he said: “We don’t have five years.”

He also quoted St Augustine (a real saint, not a failing hospital):  “Oh Lord, make me virtuous, but not yet.”

And just to be clear, this is guidance Simon Stevens urges us to reject.

Religious affairs editor: Julian Patterson


With thanks to Andy Cowper at Health Policy Insight for the transcript, which is available here.

barry fitzgerald
barry fitzgerald says:
Jun 05, 2015 06:47 PM
I know the blog isn't about obesity but just as laws have changed smoking habits so laws have changed drink/driving. Some people say that societies attitudes have changed towards drink/driving. Maybe they have but I'll wager the main reason people don't drink drive is the threat of loss of license and prison time. If the drink/driving were removed then there would be more drink/driving.

Legislation aimed at the food industry is just one line of attack on the "war on obesity" and on its own it is doomed to fail just as the war on terror and the war on drugs have failed. For strategies that may have more success how about making cities more cycle friendly, stop selling off school playing fields, bringing back old fashioned Home Economics lessons in schools.

Just a thought.