Intended for healthcare professionals


Array of out-of-hours and emergency services is confusing to public, says NHS chief

BMJ 2014; 349 doi: (Published 24 November 2014) Cite this as: BMJ 2014;349:g7186
  1. Nigel Hawkes
  1. 1London

The NHS needs both change and more money to remain sustainable, the chief executive of NHS England told the Future of Health conference in London on Friday 21 November. But Simon Stevens declined to say just what form the changes should take, adding that different models would suit different places, albeit not “hundreds” of different models. “There might be, I don’t know, four or five different models that people will choose from, depending on what’s right for their communities,” he said.

Promising “a big journey” over the next five or six years, Stevens called for greater integration of care to overcome historical divisions between physical and mental health services, between health and social care services, and between primary and specialist care services. Although people were rightly proud of primary care in England, which he said was world class, Stevens said that there was too much fragmentation and too much confusion among the public.

“What does it feel like if you are an anxious parent with a child who is sick on a Friday night or a Sunday morning? Where do you go, what do you do? How do you interact with the services? We have this confusing array of NHS 111, GP out-of-hours services, urgent care centres, walk-in centres, or you can go to A&E [the accident and emergency department]. Is it any wonder that we are seeing rising pressures in A&E departments, 1.3 million more people going there than even four years ago? We need to change that.”

Without change, he warned that the NHS in England, according to one estimate, would need to build 34 new acute hospitals just to deal with the rise in short term emergency admissions. “Do we want to go down that route, or do we want to reshape the way care is delivered? I think there is a growing consensus in the country that the preference is for the latter.”

But even if that were done, he said, more investment would still be needed over the next five years. “That’s why we said quite explicitly in the NHS five year forward view1 2 that our offer to the people of this country and to the next government does require funding at a higher level than has been possible over the course of the past several years—not growth at a rate anywhere near as high as it did in the early 2000s, but somewhere between the two.

“But if we can get that right there is a very positive future on offer, and there is no need to doubt the sustainability of services that the people of this country rightly attach great importance to.”

In response to a question Stevens promised to accelerate access to talking therapies and to treatment for psychotic episodes. Standards would be introduced to enforce faster access, as had happened for hip implants and cataract operations. He came under some pressure—at a conference that focused on the role of the patient as an active collaborator in care—to explain why doctors still did not see patients as people with competencies.

He argued that measures such as the “friends and family test” and patient reported outcome measures, combined with new technology to facilitate social networks in which medical professionals could participate with patients, had the potential to make the scales drop from people’s eyes. “A lot of different things bear on this,” he said, “and hopefully we’ll be in a better place in a few years.”


Cite this as: BMJ 2014;349:g7186


  • Interview: Simon Stevens, the man charged with saving the NHS (BMJ 2014;349:g6895, doi:10.1136/bmj.g6895)