The appointment of Simon Stevens as the new chief executive of NHS England has unleashed a torrent of comment, speculation and expectation.
- This is a largely rewritten version of the HSJ editorial posted on 23 October.
Mr Stevens is wisely saying nothing in public, but Tony Blair’s former health adviser has been a regular commentator on health reform – including writing a regular coulmn in HSJ for the majority of the last eight years – and it is possible to make some educated guesses as to his approach.
‘Much uninformed comment has labelled Mr Stevens as “a privatiser”’
Mr Stevens’ role for UnitedHealth has given him a global understanding of which incentives work – and which do not – when trying to create an effective, safe and efficient health service. This is also no academic understanding, UnitedHealth spends $150bn purchasing healthcare for its members. That buys you a lot of learning.
His wide international experience has taught him there are many ways of skinning the health reform cat and we should not be surprised if an NHS England under Mr Stevens’ leadership actively trials alternative approaches to change in areas such as urgent care or joint health and social care commissioning.
While the new NHS England boss understands the inherently complex nature of healthcare systems, his inclination will be to increase the clarity of policy and therefore remove the perceived risks of taking decisive action in areas such as reconfiguration.
If Sir David Nicholson valued loyalty and the ability to exercise control above all other characteristics in those working with him; Mr Stevens will want his compatriots to demonstrate the emotional intelligence and shifts in behaviour which display awareness of changing demands and context.
Mr Stevens last strode the UK corridors of power during the era of New Labour’s “big tent” and he will look to tackle the increasingly polarised views which HSJ has noted developing among the service’s various power blocks.
One of the big differences with past regimes is that Mr Stevens is likely to want to persuade the NHS (and the government) to abandon its obsession with administrative neatness, with every area structured and running in the same way.
While he will champion the development of clinical commissioning groups, he can be expected to be relaxed if providers or even local authorities drive change in a specific locality. Whoever has the best chance to succeed will get his backing.
Much uninformed comment has labelled Mr Stevens as “a privatiser”. He is no believer in full market competition for NHS services. However, he understands the advantage of having contestability as an option to incentivise improved performance. Should Andy Burnham ask, Mr Stevens would likely advise against his idea of a moving to a “preferred provider” model in which the local NHS hospital trust became the default deliverer of services.
Bask in the public eye
Mr Stevens will face challenges. Not every one of the policies he was influential in shaping worked out and he played a robust part in a culture in which adherence to a centrally developed plan was viewed as among the highest of virtues.
He will also join an organisation which is yet to find its feet amid a worsening financial situation and whose every misstep rapidly becomes public knowledge. This is a mile away from both the behind scenes influence he wielded as an adviser or the super slick corporate machine at UnitedHealth whose operations were described recently as “buttoned down tighter than the CIA”.
Will he rise to that challenge? Time will tell. But Mr Stevens’ experience means he has got a fighting chance of leading the NHS towards a sustainable future.
In the meantime his influence is already being felt. NHS England is preparing its “case for change” – effectively a vision for the service’s development - and it would be very surprising if the incoming chief executive did not have shared sign off.