Brickbats and plaudits as Stevens e exits

The decision of prime minister Tony Blair's health adviser, Simon Stevens, to join UnitedHealth Group, the biggest healthcare company in the US, has surprised many - both inside and outside the NHS.

Mr Stevens, who has been the intellectual driving force behind many of Labour's health reforms, last week announced he would become a vice-president of the private sector firm, as well as president of its planned European operation.

HSJ understands that Mr Stevens had wanted to leave his Number 10 post for some time, apparently stepping back from the move when former health secretary Alan Milburn quit last summer. But the decision to join UnitedHealth Group came as a surprise.

Frank Dobson, the former health secretary who brought Mr Stevens into the Department of Health, has expressed surprise at Mr Stevens' decision to join UnitedHealth, which will be targeting NHS business .

Mr Dobson, who first brought Mr Stevens into the DoH as a policy advisor in 1997, said: 'I am very surprised that he has taken this decision. It seems a long way from the man I used to know who was deeply committed to the NHS, who supported the NHS and would have had very little truck with the private sector. What's changed? I do not know.'

Mr Stevens' decision to move to UnitedHealth was assessed by the Cabinet Office business appointments committee. The discussions remain confidential, according to a spokesman for Number 10, but he suggested that Mr Stevens had no conflict of interest as he had 'not been involved in the procurement' of private-sector services for the NHS. It is expected that there will be a three-month gap between Mr Stevens leaving Number 10 and joining UnitedHealth.

Mr Stevens has been enormously influential in importing US models of care into the NHS.

Two years ago he made a highprofile trip to the US, to look at the way the US system focused on preventive care. He was reportedly struck by UnitedHealth's Evercare model of disease management. There are currently nine Evercare pilots in the UK, aiming to reduce hospital admissions among elderly people.

The issue of managed care has become crucial to policy-makers within the DoH. It is currently finalising details of its so-called 'five-year plan' - a document outlining the government's policy direction until 2010.

Dr Richard Smith, editor of the BMJ who has also been recruited by UnitedHealth, as chief executive of the company's European operation, said that he expected the company to win more business from the NHS as consultants than by providing large-scale services.

Few have denied the importance of Mr Stevens as one of the key drivers behind Labour's health reforms. It has been suggested that when he became Mr Dobson's policy adviser in 1997, he was undecided on the direction he was eventually to take - most importantly the perceived need to unleash competitive forces.

The eventual direction chosen has been most obvious in policies like patient choice, the market incentives of payment by results, the expanded role of private-sector providers and the increased freedoms of foundation trusts from Whitehall control.

Andy McKeon, Audit Commission managing director of health and former DoH director of policy and planning, said: 'There is not a major health policy that he has not touched - from the NHS plan to the tariff to the pay reforms.

'He has also had a core impact on the choice of national service framework areas. He has been enormously influential.'

He added: 'I do not think that when Labour came to power there was any awareness of the direction the NHS needed to take and the importance of market reforms and the role of the private sector.

These ideas developed I think between 1997 and 2000.'

NHS Confederation policy director Nigel Edwards said: 'He had an important role in shaping policy, but he also had a powerful veto. I think the DoH, in developing policy, had a very strong idea of what Simon's views would be.

That is a strong influence.'

Mr Stevens' position will be filled by Professor Julian Le Grand. Currently on secondment to Number 10's policy unit, the London School of Economics academic is not expected to push for major changes to current health policy.