Webchat with Simon Stevens, Chief Executive of NHS England, Friday 8 September at 1pm

[BojanaMumsnet]

Hello

We’re pleased to announce a webchat with the CEO of NHS England, Simon Stevens, on Friday 8 September at 1pm.

NHS England leads the National Health Service in England, setting the priorities and direction of the NHS to improve health and care. Simon is accountable to Parliament for over £100 billion of annual health service funding. You may know him from his appearances in front of Commons select committees which have occasionally hit the headlines.

Simon joined the NHS in 1988 and became a frontline NHS manager, leading acute hospitals, mental health and community services, primary care and health commissioning across different parts of England. He also served seven years as the Prime Minister’s Health Adviser at 10 Downing Street, and as policy adviser to successive Health Secretaries at the Department of Health. He has been leading NHS England since 2014. Simon is married with two school-age children.

Please do join the chat on Friday at 1pm, or if you can’t make it, leave a question here in advance. Please do share the webchat on social - the more, the merrier!

As always, please remember our webchat guidelines - one question each, follow-ups if there’s time and please keep it civil.

Thanks
MNHQ

My daughter's consultant recently wished to access the heel prick test card taken antenatally to compare with current bloodwork. Apparently she is unable to access the stored card because since she was born we have moved from SE England to SW England. What is the point in storing all of these cards (no doubt in secure, temperature-controlled conditions etc. etc.) if a house move of 50 miles renders them useless?

Isn't it time we just accepted that the NHS needs more money and start funding it properly, even if this means raising taxes?

Can you find some way of speeding up ambulance arrivals at A&E?

The Ambulance staff have to hand over to the nurse at booking in and in that time, can't go on any other calls. In my case, we waited 40 mins, I wasn't an urgent case but it was 'advisable' I attend A&E (RTA). It was so frustrating to hear the constant calls to see if they were free as there were so many cases waiting on an ambulance

How many NHS staff are sitting one really good ideas for more efficient health care knowing that hospital bosses will only ever listen to their latest management consultant. ?

I understand that the Better Births Report suggests that Commissioners use alternative providers in order to widen the choices for women. Can Mr Stevens advise what examples of this have occurred or are commissioners simply maintaining the status quo.

Plumbing, heating and ventilation systems in hospitals is probably below your pay grade, but please make a note that it is more expensive for a contractor to comply with every local trust's H&S individually. We are adding £1000 to every quote because the NHS cannot determine a common universally acceptable standard of proof/evidence for personal, criminal and professional competence. Every new bid requires submission of the same facts in different formats. We waste hours; it all goes on the bill.

How can you speed up A&E and improve the facilities for those waiting on treatment and those waiting with them.

So so many questions as a front line clinician but will stick to my own speciality.
I currently have children waiting up to and beyond 40 weeks to have decayed, infected and painful teeth extracted under general anaesthetic, these are young children who through no fault of their own need this treatment.

I would ask if you think this is acceptable?

I have over a year waiting list for adults with complex additional needs (who may be unable to communicate they are in pain or who start to display self-harming/violent behaviour to try to communicate) to have dental treatment under general anaesthetic (the ONLY way they can receive treatment)

I ask again if you think this is acceptable?

For dentistry, given that the situation I describe is replicated across the U.K. Do you think it is currently a good use of NHS resources to provide orthodontic treatment on the NHS? Any patient receiving NHS orthodontic treatment in a high street orthodontic practice is a cosmetic patient. There is no eveidence to support improved dental health and no evidence to support improved psychological health following orthodontic treatment

I look forward to your answer, but will be at work try to fire fight for the patients I described above.....

Simon

Thanks for doing the webchat. Lots of questions but I'll stick to the money ones.

How do you think we can move forward with the consolidation and centralisation of acute services to meet savings targets driven by the government, when MPs are always leading the charge of protests against any local service closures?

Do you think the fact that a huge proportion of providers are failing to meeting their financial targets, despite previous track records of excellent management, might be indicative of the target being unachievable?

Oh one more; CCGs are adding more and more items to their 'procedures of limited clinic value' lists, very often on the face of advice given by the royal colleges. If we age going to arbitrarily ration treatment, should we not at least take the expert views and have some sort of consistency across England?

Three CCGs now offer zero cycles of IVF. This should be a national embarrassment!

What are you doing (not saying you will do) to address the shockingly poor morale of NHS staff?

What's the point in wasting effort to recruit new staff if the retention levels are so bad?

What is the plan to recruit more nurses (especially for the impending demographic timebomb) that doesn't mean downgrading posts or relying so heavily on reconfiguring teams to more heavily feature band 3 or 4 posts?

How much exactly did it cost to disband PCTs, lose organisational knowledge and goodwill only to essentially reestablish them as CCGs?

How can the secretary of state for health justify accepting a significant payrise and perks for himself but argue that a payrise for NHS workers after 7 years is unaffordable?

How are you and DH working to highlight the positive achievements of the NHS on terms of day to day but against international comparisons on outcomes and management costs as a percentage of budget?

How is NHS England holding primary care providers to account with such weak post pct systems, especially when most dentists aim for basic care and to pass on any more complex than scale and polish to hospitals or their private arm when they insist on telling patients that the NHS does not fund necessary treatment?

Why should NHS staff trust that you or the current government have the best interests of patients at heart and that decisions don't have a darker ideological meaning behind them?

Is the plan to open the NHS up to American companies?

What efforts are being made to address the issues in social and post discharge care that mean the NHS holds a greater burden of cost and care that it's not being funded or supported to manage?

What are you doing about the targeted negative and demoralising language used by the politicians in the government and department of health when talking about the NHS?

How can mental health referrals be speeded up - particularly for young people?

Why is it a two year wait to receive the first appointment for autism assessment? (not the diagnosis, just the letter for the first appointment)

Hi Simon,

If you could make one single, immediate change to the way the NHS is run, what would it be?

I find some nurses very brusque and seemingly uncaring. (Others are great.)

A retired Nurse family member said since project 2000 many Nurses think they are superior to older nurses she found they were the ones to try and get out of changing dressings and turn patients, she's glad to be retired.

I have chronic health issues and find in my experience, in particular A&E nurses lacking in empathy. I wonder if they have compassion fatigue from overwork?

Some really sensible ideas here, hope he listens. Streamlining medical records would not only ensure consistent care but save time in appointments as you won't have to do the same number of tests.

My question is about food in hospitals. Whenever I've been in I've had to get fruit and veg brought from home as there's very little on the menu. A nurse once saw me with a jacket potato and cheese and commented on the salad being good today, I didn't get one yet she had in the canteen.
Good healthy food doesn't have to be expensive but its inclusion in hospital could make sure people get well sooner and therefore home sooner

Hello

Why is there no consultant level HCP in charge of pressure sores? It's a nurse led field, which means in practice no access to proper treatment as nurses, even the rare TVNs, do not have real executive power in the hierarchy of the NHS. Patients with long term sores languish, costing huge, runaway sums of money (£150k+ pa), while similar wounds on different pathways (burns, diabetic ulcers etc) get access to targeted, aggressive treatments to close them (not just surgery, autologous fibrin glue, epidermal harvesting...). Once basic pressure prevention is in place, Nurses are helpless to push for anything other than "trying a different dressing" and recommending home care regimes that are punishing and short sighted: 2 hourly turns with a sole family carer.

[To background, briefly, I almost died (sepsis) complying with nurse prescription -providing 24h care on a 2 hourly turn regime - and my husband's care costs consequently ballooned fivefold. Years later the wound is still present and there's simply no plan or pathway to do anything but change the dressing and turn him over and throw more money on the fire, until they make the next round of cuts and then we've been told he will be forcibly institutionalised (at 38 with a job and family) or I will be left to die caring for him. Connectedly, given that CCGs are now routinely threatening severely physically disabled adults with forcible institutionalisation, wouldn't it be humane to, at the NHS England level, spell out what will get you locked up under this new system, so people can avoid it, instead of it being used as an instrument of psychological terror in this way?]

Pressure sores are an orphan field, but they are so common. Isn't it about time they got a real department in the NHS, with some doctors who can actually treat them?

I would also like to say that when I was very seriously ill in hospital, I got excellent care and I am very grateful to the wonderful staff who looked after me and saved my life. Thank you, NHS.

Do you see it as a problem that a majority of NHS staff appear to see patients as a pain in the arse?

Quite apart from its deadly effect on patients, surely this organisational culture must lead to poor staff motivation?

Hi Simon, thank you for doing this webchat, I'm really looking forward to reading your answers later.

My question is about the NHS surcharge for non-EU immigrants and students. Do you think that it's a good idea and is that the best way to help the NHS cope with pressure on resources from immigrants? Does any other country have a better system? Thank you.

Speaking as an inpatient mental health nurse, can I ask if you agree with the continued push to treat more and more patients in the community as outpatients and close increasing numbers of inpatient beds? In my experience whereas there definitely are some patients who benefit from treated as outpatients, there's also a large group of patients with serious mental health issues that would really benefit from early intervention in an inpatient facility when their mental health is deteriorating. However due to bed cuts we are now in a situation where only patients that are in severe crisis are being admitted, often after a prolonged period of deterioration in the community, and often only for a night or two before they are discharged again. These patients would often really benefit from being admitted earlier before they had a chance to deteriorate to the extent that they are in crisis, but we simply don't have the bed capacity anymore to do this.

Also, what do you think about the 1% pay cap? And when will it end?

NHS treatment for ME/CFS is harming patients. The British evidence is flawed, as reported in the New York Times.

Don't take my word for it, ask three Nobel Laureates. www.omf.ngo/scientific-advisory-board

I am certain they would be delighted to hear from you.

The NHS is well aware a large proportion of CFS/ME patients are misdiagnosed.

Hi Simon - can you say something about child and adolescent mental health services? They seem to be in an absolutely appalling state tbh. When are things going to get better?

Mine is more of a request. Please can you provide more part-time, preferably funded, opportunities for people to train as nurses. There are lots of us out here who want to do it, but can't.

Why have you not tackled the post code lottery in relation to IVF provision? It is incredibly unfair that balancing the books in local health economies is done off the back of women suffering from infertility when restricting it is purely a cost control exercise.