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Editor's blog Wednesday 9 February 2011: Simon Stevens on disruptive reform for innovation

United Health Group CEO Simon Stevens was one of the key influencers of the NHS reforms of the past decade.

His formidable intelligence and strong communication skills made him an iconic figure in health policy over the period 2000-10, despite his leaving for the USA mid-way through the decade.

Perhaps a significant part of this was his long-standing interest in the commissioning function. The NHS's problem at the start of the decade was one of under-capacity in provision. As such, the National Hospital Service devoured the majority of the available attention and resource.

Meanwhile, the real crisis in dentistry was the lack of teeth in PCT commissioning.

This blog, which he wrote for the Harvard Business Review last May, touches on the ever-topical issue of how to introduce innovation in healthcare.

Simon's blogpost considers the US model, but makes generalisable points: he states that "slowness to adopt new technologies and new ways of working partly explains health care's cost problem".

Posing the question of how payers of healthcare (plans and insurers in the US context; PCTs and consortia-to-be in UK terms) can incentivise the adoption of demonstrably effective innovation, Stevens has two main ideas.

Firstly, he suggests that commissioners "should look to become 'care system animators' and not merely risk aggregators and transactional processors.. Data use and incentive planning are, he proposes, potentially-effective agents of change.

Secondly, he proposes that commissioners "should act as change agents, partnering with others to bring good ideas to scale". He gives the case of a United-led programme in the States which helps patients with pre-diabetes address various lifestyle issues to lose weight, so as to avoid the development of the disease.

It's interesting to consider the extent to which the reforms Stevens co-authored delivered on either of these two concepts. The former is (I think he might be the first to agree) the area where the NHS delivered least.

The reasons are various: NHS culture regarded PCTs as 'low status'; target culture over-rode most other management considerations; the medical professions often felt (and indeed were) criticised and marginalised by the reforms; rhetoric about 'better care closer to home' was un-matched by resources and incentives.

Partnering with others to deliver at scale did happen - a bit, in some places. The private sector was used in parts - Birmingham East and North's work with Pfizer Health Solutions on Birmingham Own Care; Tribal's FESC collaboration with Ashton, Wigan and Leigh PCT. Elsewhere, the NHS had the radical idea of partnering with itself and social care: Torbay Care Trust, Cumbria PCT and others.

The NHS has problems with innovation: it's viewed as costly (even if there is a medium-term potential for savings); and the 'not invented here' syndrome remains depressingly indicative of closed organisational cultures being pretty endemic.

Perhaps lean years will re-awaken the appetite for innovation, making necessity the mother of invention, learning and theft of good ideas.