I guess I should write about what it was like interviewing the CEO of NHS England, Simon Stevens.
I enjoyed it. It’s been a while since I’ve done an on-stage Q&A (the last time was TEDMED in 2013) and, during preparation, I was reminded of how hard it is. You need to be informed while, to some extent, holding back your opinions. And you need to be interested in the interviewee’s answers on behalf of the audience, the idea being to anticipate the kind of follow up they might want.
— Marcus Grant (@MarcusxGrant) October 20, 2017
On the audience, I have to say they were way more demanding than I was. I was impressed by their concerns about whether the NHS needed to be careful in getting in bed with private housing developers, whether the NHS is really aware of its role in medicalising ageing and pathologising childhood, and whether the down-turn in the growth of life expectancy was being matched by the NHS’s response (implicit to the question was the answer, ‘no’). These were all really important questions to ask and debate.
The format – a Q&A from stage – does not lend itself to debate. I didn’t think Simon’s answers really addressed the questions from the audience but I also realise that it’d have been impossible to do so without a significant to-and-fro, tightly chaired – something that the format didn’t lend itself to.
Which brings me to his ‘answers’. Being the CEO of NHS England must be part execution and part politics, and that came through in how he responded. You have the sense that he’s answering but he’s also going off to topics that seemed to matter to him. He uses evidence – citing papers, including one published that morning (I think) on air quality and health – and stories in an impressive display of knowledge and narrative that make you feel valued but sometimes – and certainly not always – it feels like clever obfuscation, wool being knitted to be pulled over our eyes.
That said, when he could be candid, he clearly was. Considering UK figures, health care in France and Germany gets about £24bn more money each year. He spoke often of things that “piss him off” . And I was left with the sense that he understands all too well that he’s not just running a health care system but handling an important part of the nation’s sense of identity (in surveys, the NHS almost always comes up as the thing that makes the British proud of who they are).
— Marcus Grant (@MarcusxGrant) October 20, 2017
I had to ask questions within the frame of the event but if I was starting carte blanche I’d want to drill further into the medicalising and pathologising mentioned above, as well as whether it really makes sense for the health system to be trying to respond to sickness without considering the deeper roots of the sickness – the increasing levels of hopelessness in our societies (he touched on this through the frame of loneliness, his point being that it’s something we can consider through housing design; I’m unconvinced but I’m glad he wasn’t advocating for drugs as a solution).
In recent times, I’ve met a few health system CEOs. The thing that strikes me is how earnest they seem to be. They’re genuinely trying to do a good job, to respond to a demand that they know is impossible to meet. The fact that health care is only part – and a very minor part – of our health seems to be something they know but what are they going to do about it? They’re keeping their show on the road, doing the best they can with what they have. They’re not unaware of the bigger picture but it’s not where they’re playing. And perhaps the rest of us need to stop asking them to.
The least convincing thing he touched on was the need to take on the food industry. He cited some data from the BMJ – The Guardian of medical journals, all angst and constant crisis but to what end? – on how much the industry spends on advertising compared to what we spend on health messages. It’s a lot more. But the idea that health care or public health is going to take them on seems far-fetched to me. Sure, there have been some successes (and some near misses that got a lot of attention) but we in health are pedestrian compared to their strategic rapaciousness. We need to find a level of nasty that is just missing in the industry, at least to the depth required.
I enjoyed chatting with Simon. Before, during, and in the few seconds we had afterwards. A colleague of mine recently described me as someone never impressed with anything – so it says something that I enjoyed it. Indeed, I enjoyed the experience, as much as the man. So, thank you, Bristol Festival of Ideas for putting on the Festival of the Future City and for inviting me to participate. And for those interested, note that my structure to the Q&A is below my bio.
People, Healthy Towns and Cities
Simon Stevens and Pritpal S Tamber
Context (5 mins)
Bristol Festival of Ideas (a Bristol Cultural Development Partnership initiative):
- Stimulate minds and passions
- Encourage debate
- Embrace difficult and challenging ideas
“Rapid urbanisation means that the vast majority of people worldwide will be living in cities by 2050”:
- Today: Half of global population in cities
- By 2050: 7 out of 10
- Movement: 60m people each year
- Places: LMIC’s world but HIC’s too
- Urban > Rural
- Urban disparities +++
- Unsafe water
- Unsanitary conditions
- Poor housing
- Environmental hazards
“Epidemiologic Transition”: Top 5 diseases by 2030:
- Depressive disorders
- Ischaemic heart disease
- Road traffic accidents
- Cardiovascular disease
- Chronic lung conditions
- NHS Healthy New Towns programme
- Next steps in the 5YFV (relevant to this agenda)
- Broader role of the NHS in cities
NHS Healthy New Towns programme (15 mins)
- What is it?
- Why are you doing it?
- Some highlights to date
- Examples of wider benefits to local communities
- Over-arching principles
Next steps in the 5YFV (relevant to this agenda) (10 mins)
- Open question to Simon
Broader role of the NHS in cities (10 mins)
From the programme: “And what is the role of the NHS in helping create future and better cities and towns?”
- Devolved power
Possible topics to explore:
- The NHS as a local economic actor (local purchasing and hiring)
- The NHS as an advocate for more inclusive societies (assisting excluded communities)
- The potential fraying of trust in the NHS brand as it gets more into advocacy
- The NHS as a vehicle to build inter-generational relationships (demographic transition)
- Whether the NHS can really shift to prevention when it has failed repeatedly to date
- The NHS’ role in fostering resilience (the capacity of people to adapt and grow)
Open to the floor for questions (20 mins)
Thanks to Andrew Kelly and David Relph for inviting us, and to the Bristol Cultural Development Partnership for having the imagination to create the Bristol Festival of Ideas and the Festival of the Future City.