The list of those who could replace Simon Stevens as NHS England chief executive is long, however relatively few are likely to be considered serious contenders. HSJ presents here the runner and riders for what has been described as the ‘fourth most powerful job’ in the UK (after the PM, chancellor and the governor of the Bank of England).

The front-runners

Amanda Pritchard, chief operating officer, NHS England

Why: Has made a good fist of the number two job at NHSE before and during the pandemic and is considered to be in ‘pole position’ for the post. Her unfussy style and focus on the details of what needs to be done — while her boss worries about the big picture — has won over many. Liked and respected by the NHS leadership community. About time the NHS was led by a woman.

Why not: The fact that she is still ‘on secondment’ from Guy’s and St Thomas’ has led some to question — perhaps unfairly — her appetite for the top job. Still yet to show any signs of having a ‘vision’ for how the NHS might develop. Relatively young, she might want to save her bid for the next opportunity, (probably) at the end of the decade.

Mark Britnell, chairman and partner of the Global Health Practice at KPMG

Why: Former teaching trust CEO, health authority chief and Department of Health mandarin. Knows how government and the NHS works and has maintained strong networks among NHS leaders. Has used 12 years of international experience to develop a distinctive view about what works and does not in health systems.

Why not: The ‘Tories appoint management consultant to run NHS’ headlines write themselves. If he is approached for the CEO’s role, this will be the third time and he has been ‘out’ of the NHS for a long time.

The hopefuls

Sir James Mackey, chief executive, Northumbria Healthcare

Why: Hugely successful and respected trust CEO. Most people assumed that after his stint as NHS Improvement chief executive, Sir Jim had had enough of life down south. Apparently not. Having failed to achieve his primary goal of ruling the north east through adding the Newcastle CEO’s job to his portfolio, he is now actively campaigning for the runners-up prize.

Why not: Those making the appointment would take some convincing that Sir Jim would not soon tire again of having to deal with here today, gone tomorrow politicians and the long commute.

Sir David Sloman, London regional director, NHS England

Why: The NHS in London took the brunt of the spring covid wave and did not buckle. Sir David oversaw unprecedented levels of joint-working across then nation’s largest and most complicated health economy. He has developed a clear vision for the capital’s NHS and made relatively rapid progress in achieving it. He will expect his record as a regional director and trust chief executive before that to put him in with a chance of the top job.

Why not: Felt by many to have insufficiently prepared the capital for the winter covid wave. His approach has left Sir David with as many detractors as supporters, with the former feeling both that he has broken too many eggs in making his omlette and that most change has been at organisational rather than service level. Can someone who has spent so long as a London NHS chief executive really understand how the rest of the service works – and convince others that he has? May consider retirement the more attractive option.

The safe pairs of hands

Julian Hartley, chief executive, Leeds Teaching Hospitals Foundation Trust

Why: Mr Hartley has turned a slumbering one back into a force to be reckoned with. Began his chief executive tenure at a primary care trust, before running acute providers across the north (with a little bit of national improvement and policy work thrown in).

Why not: Did not much enjoy brief national role helping leading NHS people strategy and has not knowingly expressed a desire for a permanent national role. There remains a lot of unfinished business at Leeds.

Dame Marianne Griffiths, chief executive, University Hospitals Sussex FT

Why: Arguably the best performing NHS CEO in the last five years. Stabilised Brighton, one of the service’s most troubled acutes which had defeated many previous leaders.

Why not: The opportunity may have come too late for Dame Marianne, whose ambitions are unlikely to include taking on a job which would swallow her life for five or more years.

Dame Alwen Williams, group chief executive, Barts Health

Why: Like David Sloman, another long-term and highly respected NHS leader within the capital. Dame Alwen took on the running of Barts in 2015 at a time when few thought the lumbering behemoth could be turned around. The huge organisation with its highly challenging demographic is now in a much better place.

Why not: Has very little experience at national level and there is much still to do at Barts with an (effective) merger with the even more challenged Barking Havering and Redbridge on the cards. Like Sir David, has actively been thinking about retirement.

The outside bets

Sir Mike Deegan, chief executive, Manchester University Trust

Why: No other acute trust chief executive has been as successful as Sir Mike in shaping their health economy in the way they wished. Relentless, focussed, determined, tough and successful, he has simply outlasted and outmanoeuvred any potential rivals. An NHS England under the Manchester boss would be a place where everyone knew their job and the penalty for not performing it.

Why not: His approach is not everyone’s cup of tea (to put it mildly). Does not appear to like dealing with the media (to put it even more mildly). Would take a lot of persuading.

Dr Tim Ferris, NHS England, Director of Transformation

Why: He’s a doctor – with an impressive track record of service change in not-for profit healthcare system.

Why not: That healthcare system happens to be in the USA. Perhaps needs a couple of years to lose the accent and get to know the British, the NHS, and its politics. More likely the next NHSE medical director.

Baroness Dido Harding

Why: Trusted by government and seen as a team player. Prepared to take on difficult, thankless jobs. Steely determination which is often underestimated. Had won a number of supporters among NHS leaders pre-pandemic for her focus on the importance of culture.

Why not: To appoint a figure with no frontline NHS managerial experience would be a brave move. The performance of Test and Trace has undermined her reputation in the eyes of many influential figures. Would be viewed as ‘too political’ by the left-leaning NHS leadership community.

Samantha Jones, senior heath adviser, No10

Why: Like Mark Britnell, a former NHS chief executive and national director who has also tried her hand working in the commercial sphere. Now newly installed in No10, as Boris Johnson’s health supremo. Has not expressed a desire to do the job, but would do so if asked.

Why not: Hard to see Ms Jones being picked over Mr Britnell if the government goes down that route. Indeed, likely to recommend the KPMG senior partner when she is asked her opinion.

Emily Lawson, outgoing NHS England chief commercial officer and incoming head of No10 delivery unit

Why: Ms Lawson was being discussed as an interim leader of NHSE between Sir Simon’s departure and the appointment of a substantive replacement before her departure for No10. It is still not beyond the bounds of possibility that the woman who oversaw the covid vaccine programme might be considered the most appropriate person to lead the NHS – after all Sir Simon is on record as saying the vaccination programme should be a model for how the service is run.

Why not: No10 has placed a lot of store in the reborn delivery unit – and will probably want to hang on to its newly appointed leader. Not worked as an NHS leader locally or regionally. 

Sarah Jane Marsh, chief executive of Birmingham Women’s and Children’s FT

Why: Punches way above her weight as the CEO of a relatively low profile specialist trust – both regionally and nationally. Has taken on some difficult national roles. One of the best connected, active and respected NHS CEOs.

Why not: Probably a few years too early for Ms Marsh to make the jump.

Rob Webster, chief executive, South West Yorkshire Partnership Foundation Trust, leader, West Yorkshire and Harrogate ICS

Why: The leading example of the ‘new’ style of NHS chief executive. Devoted to system working and reaching beyond the boundaries of the NHS. Very strong on culture.

Why not: He was not a natural fit as CEO of the NHS Confederation and may feel more comfortable exerting influence from outside NHSE.