Having led medical businesses around the world and advised the Blair government on health policy, the chief executive of NHS England now oversees an annual budget exceeding £120 billion. Simon Stevens explains the importance of diversity, tech investment and taking responsibility for employees’ wellbeing
You’ll learn a lot if you deliberately seek out a broad assortment of jobs, enterprises and sectors. I have been working for 31 years, a dozen of which I’ve spent overseas. Early in my career I took on a variety of roles with different organisations. You can draw on those experiences later and it is possible to transfer your skills to different industries mid-career too. Always try to continue learning.
Most industries need to become more diverse. We should ensure that all of the people we recruit have access to experiences that can help them to achieve their aspirations. As a large employer, the NHS needs to be flexible enough to design new career paths that take account of young people’s changing expectations.
The NHS is an institution that makes people proud to be British – even more so than our armed forces, the BBC or the royal family. With that comes a responsibility. We must keep all that’s good about the NHS but also continue the evolutionary process that’s been going on for 71 years. It’s about finding the right impetus for change while respecting the deep reservoir of support for the service. It’s not only the biggest employer in the UK; it’s the biggest in Europe, with 1.3 million workers nationwide and 350 different types of job. There’s a lot of public appreciation, but also a great deal of scrutiny.
I wouldn’t criticise the public debate about the NHS. To some extent, that would be like a fisherman cursing the sea. But, quietly in the background, there is constant improvement. Your chances of surviving a heart attack or a stroke have doubled since 1990, for instance, while annual deaths from breast cancer have fallen by 18 per cent over the past five years. Medical interventions are becoming more personalised and cancer treatments involving cell manipulation could represent a cure. Changes to the provision of health services will accelerate.
Tech investment is key to making productivity improvements. The NHS’s productivity in England is increasing three times faster than that of the wider economy. We’ve obviously been through a period where spending per person has come under pressure, while at the same time we’ve been treating many more people. But we’ve focused on ensuring that money invested in the health service is used wisely and produces the maximum bang for your buck. In the next five to 10 years we will invest more in productivity-enhancing technology, innovation and infrastructure.
Even in this complex and fast-moving world, we can still make long-term plans. First, we look at the big killers, benchmark our progress against that of the world’s best and seek opportunities to move forward over the next decade. We have done that for cancer, heart disease, stroke, respiratory disease and mental health conditions. We will make some specific changes to continue driving improvements in these areas. For example, we want to make cancer diagnoses sooner and so improve patients’ chances of effective treatment. For that to happen, we need new screening programmes and earlier testing.
The NHS needs to work together with business. Partnerships with industry are important when it comes to prevention, particularly when ensuring that NHS funds are spent in the best way, because they help to tackle avoidable sources of illness. There is a big debate about air pollution, for instance, which by some measures causes up to 40,000 premature deaths each year.
Workplace health is significant – and sickness absence costs employers billions of pounds a year. About a third of those losses result from musculoskeletal and mental health problems. Employers in the UK don’t pay for health services in the same way as those in other countries, but they can contribute in a different way by acting to improve working conditions.
Employers that invest in workplace wellbeing will benefit. Direct advantages from this, alongside a reduction in sickness absence, include the ability to attract the next generation of talent at a time when unemployment is at its lowest for nearly 45 years. As retirement is becoming more flexible, we need to collectively help people stay healthy in their fifties, sixties and seventies – not least because occupational pensions are not available in the same form as they have been. This collaborative approach will help keep the tax burden low for employers, increase productivity and aid recruitment.
Small firms need particular help in supporting the wellbeing of their employees. This is a real challenge for businesses without HR infrastructure. When I spoke at the IoD’s 2015 annual convention, I suggested the case for considering a win-win arrangement, such as an employer’s national insurance incentive, to invest more in employee health and wellbeing. That’s worth further investigation.
When it comes to mental ill-health, preventive measures work. Many millions of us will live with anxiety, depression or other treatable conditions at some point. Employers can help here, whether that’s by training workers to be mental health first-aiders or by reconsidering the kind of unhealthy culture that can pervade organisations. I include the NHS in this as an employer – we have implemented health support programmes for all doctors, for example, but we have a lot further to go in this area.
I had a health wake-up call of my own while I was working in the US. When I renewed my driver’s licence and needed to update my information, I realised that my weight had increased quite a bit. As it happened, my employer had recently introduced a workplace health scheme that helped me to get back into shape. Today I have two school-age kids who keep me on my toes and I’ve also taken up offshore sailing. It helps me to stay fit and find the time to switch off.
I believe that, when you formulate a rational case for something, it will often be heeded. Identify things that make a real positive difference, choose the right moment and build a coalition of support. For example, in 2015 we were having real difficulty recruiting nurses, accentuated by the UK’s short-sighted immigration restrictions. Ballet dancers were on the official shortage list, but not nurses. Once we made that comparison, the policy-makers said: “Oh, yeah. Actually that’s wrong,” and they did something about it.
Working as a non-executive director can give you a range of valuable insights. I serve on the board of a US foundation, the Commonwealth Fund, which keeps me in touch with developments in other parts of the world. When I lived in the US, I sat on the board of the Minnesota Historical Society during the 150th anniversary of the US-Dakota war of 1862 between the native Americans and the European immigrants who were moving through. The feeling is still raw in a number of communities – and it posed tough questions about what a cultural institution should do on issues such as historical truth-telling and the ownership of artefacts.
People don’t just choose a job; they also choose a boss. I have worked with a range of bosses and I’ve learnt important lessons from each one. All of them were different, but they influenced me hugely.
Simon Stevens joined the NHS in 1988, having worked as an economic analyst in Guyana after graduating from Oxford. He held several operational management jobs before entering Whitehall in 1997 as a policy adviser to successive health secretaries and, latterly, the PM. In 2004 Stevens moved into the private sector with US giant UnitedHealth Group, where he took senior roles including CEO of its medicare business and president of its global health division, with services in EMEA, Brazil, China and India. He returned to the UK in 2014 to take up his current position. He has also been a visiting professor at the LSE and a trustee at both the King’s Fund and the Nuffield Trust.
Simon Stevens will be speaking at the IoD members’ evening on 5 September – an event that’s free for members to attend. Visit iod.com/events to book your place. For information about the IoD’s Mental Health and Wellbeing in the Workplace campaign, visit iod.com/mentalhealth