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Why Simon Stevens - more radical than most Tories - may save the NHS

Simon Stevens may make more difference as chief executive of NHS England than anyone has yet realised

29 March 2014

9:00 AM

29 March 2014

9:00 AM

In a valedictory interview, Sir David Nicholson was quite frank about the state of the health service that he has run for the last eight years. ‘In its current form,’ he declared, ‘the NHS is unsustainable.’

It is hard to imagine Simon Stevens, who takes over as NHS England chief executive this week, having to say that when he leaves. His friends know him as an experienced reformer, a policy expert and a radical. His CV causes some suspicion in Tory circles — he is a former adviser to Tony Blair (I’m also guilty in that respect) and was a co-author of the last Labour government’s health reforms — but that is precisely why he will be so valuable to David Cameron now.

It is a measure of the scale of the task facing Stevens that politicians and health service officials alike are all already shivering with anxiety at the thought of next winter. They fear a flu epidemic, an NHS system unable to cope — and a fiasco which may determine the result of the next election.

This is familiar territory for Stevens. It was after a similar flu outbreak that he co-wrote the NHS plan presented in 2000 by Alan Milburn — a market-orientated revolution which redefined the NHS as a system for paying for healthcare, but not necessarily providing it. Does that put him on the left, or the right? The answer is neither: he left No. 10 a decade ago and has had no political affiliation since he moved to the US to work for the American company UnitedHealth Group in 2007.

Many will ask if he will find it hard to work for Jeremy Hunt, given his closeness to Alan Milburn and Tony Blair. One answer, of course, is that he doesn’t work for Hunt — he works for the independent board of NHS England.


This is something the public often fails to understand: between them, successive Labour and Tory governments have put the NHS outside day-to-day political control. If a bedpan is dropped in Tredegar, to adapt Nye Bevan’s famous remark, it will be Stevens not Hunt who hears it reverberating.

Before Stevens agreed to take on the NHS he took counsel from his colleagues. One told him: ‘There are 100 reasons not to take the job, and only one reason to take it — your country needs you.’ And so Stevens cheerfully accepted the inevitable pay cut for moving from the American private sector to the British public sector; indeed, he has taken a voluntary 10 per cent cut on the salary of his predecessor.

Simon Stevens was born on a Birmingham council estate 47 years ago. His father was a Baptist minister and he went to the local comprehensive and then on to Balliol. His glittering undergraduate career at Oxford was crowned by becoming president of the Union. Then, after a brief spell working in Guyana, he joined the NHS management trainee scheme. His first job was in Consett, County Durham, so he has no end of front-line experience.

Stevens set out his vision for the NHS in an essay for a pamphlet published by the think-tank Reform. The current management fad for running the entire NHS as if it were ‘one big hospital’ is doomed, he says. To avoid a crisis, the NHS needs ‘political stewardship, managerial execution, clinical engagement, and public communication’.

He is scathing about the way that almost all NHS reorganisations focus on ‘rearranging the administrative deckchairs’ rather than transforming patient care. As he puts it: ‘How can a quarter of NHS trusts get away with having their “value for money” accounts qualified by their auditors? How can a fifth of hospitals treat their older patients without dignity or compassion? And how is it that a single hospital in mid-Staffordshire could have been responsible for killing its patients at a level equivalent to two or more Lockerbie air crashes, yet apparently no one noticed or did anything?’

Stevens’s passion is transparency. He wants patients to have access to the same knowledge as their doctors. At UnitedHealth, he developed a system for ranking 250,000 doctors against national standards of care, and then ranking them again on value for money. This meant, in effect, listing the best doctors by price. Such transparency makes NHS bureaucrats recoil in horror — but it works. This system, applied to organ transplants, has led to a 5 per cent improvement in outcomes — and halved costs. As he puts it: a good health system requires transparency, the sharing of data and empowered patients.

This agenda — better outcomes at half the price — has an obvious appeal for an NHS operating against a backdrop of austerity. It goes hand in hand with moving services out of hospitals and into communities.

As Health Secretary, Jeremy Hunt has positioned himself as an NHS reformer, a champion of patients who is unafraid to challenge the system. It’s a worthy endeavour, but one for which he’ll need serious support. If he is serious about saving the NHS, then he will find the perfect partner in Simon Stevens.

Got something to add? Join the discussion and comment below.

John McTernan was Tony Blair’s political secretary from 2005 to 2007, and Julia Gillard’s director of communications from 2011 to 2013.

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Show comments
  • Mark

    “between them, successive Labour and Tory governments have put the NHS outside day-to-day political control”

    Lansley’s legislation may have intended this but the reality is very different. Hunt phones up hospital CEOs failing the 4 hour target and is reputed to have a chart of every “never event” (untoward incidents that shouldn’t occur) on his office wall.

  • “At UnitedHealth, he developed a system for ranking 250,000 doctors against national standards of care, and then ranking them again on value for money. This meant, in effect, listing the best doctors by price.”

    Well, only half of that will work in the NHS because ALL hospital doctors are salaried but in the US hospital doctors bill for their work.

    “Such transparency makes NHS bureaucrats recoil in horror — but it works.”

    No, such bureaucracy makes NHS managers recoil in horror. You really don’t think such a ranking system occurs without any administration?

    “This agenda — better outcomes at half the price — has an obvious appeal for an NHS operating against a backdrop of austerity. It goes hand in hand with moving services out of hospitals and into communities.”

    Psst here’s a clue: there is no evidence that moving services out of hospitals into the community saves any money. Moving services into the community may even be more expensive. On the other hand it may be nicer for a patient to have a specialist make house calls on them, but in times of austerity it is actually better to centralise the expensive resource (the specialist) and make the patients go there.

  • Paul Johnston

    It’s great that Jeremy Hunt is “a champion of patients who is not afraid to challenge the system”. Great move! Let’s all deny any kind of responsibility for the system (and avoid any real responsibility for making it better). Instead let’s focus on our role as fearless but unfortunately rather powerless champion of the underdog! Now how can Mr Stevens pull off a similar move?

  • barrydavies

    Well he is off to a bad start repeating the proven lie of mid staff killing anyone is a disgusting thing for someone in his position to posit. If this is going to be the standard then we are in big trouble.

    • Richard

      I think it was proven – the shame of it is that no one is paying a criminal cost for the disgraceful running of that hospital.

      • barrydavies

        You are correct the lie has been proven, in the Francis report, the shame is that the people responsible for underfunding the NHS and those responsible for implementing the trust system in the first place are not facing criminal charges, that is the disgrace, and remember the man who this fool has replaced was promoted for his good management of Mid Staffs, during the period of the claims.

  • Oh dear wonder what he will have to say about the 100,000’s of cases of loved ones of the departed who will be asking VERY serious questions about the “Liverpool Care Pathway” aka the pathway to doom…As the old saying goes “YOU CAN’T KID A KIDDER” When will these power crazed demons – that currently run this country, and not for too much longer, thank God – realise that you can fool some people some of the time but you can’t fool all of the people all of the time.

    • David Booth.

      You mean Labour will get back in and start to improve the NHS their way???
      Wait a minute, didn’t we just have 13 years of Labours “improvements”, years that seemed to have been rather profitable for the Funeral Directors in the Mid Staffs area?

  • agneau

    Given Nicholson demonstrated he knew absolutely FA about the NHS at his various PAC appearances and indicated he was responsible for even less, why would we listen to him about anything?

    • barrydavies

      I get the feeling Simon Stevens is going to make Nicholson look like the most able manager NHS England has had.

      • agneau

        I hope you are wrong – it’s all a bit N Korea.

        • barrydavies

          Not really, they were quite successful.

          • agneau

            Oh, I see. I hadn’t correctly divined your attitude towards your tenants – thanks to M Python. Subject: Re: New comment posted on Why Simon Stevens – more radical than most Tories – may save the NHS

          • barrydavies

            It’s all comparative, and which part you look at, I don’t have any tenants, never have had.

  • paulthorgan

    The NHS just needs to be abolished. It is incapable of reform as it is unable to fund its operations properly and is dominated by political agendas in a way that no other health system developed country in the world is. It is not the case that it is run for he benefit of the people of the UK. In fact the UK is run for the benefit of the NHS.

  • David Booth.

    I thought the last clown Nicholson was supposed to the only person who could hold the NHS “reforms” on track hence his ability to dodge the bullets over the Stafford debacle.
    When will politicians on all sides realize they are managing the NHS to death.

    • barrydavies

      When they are placing the headstone on its grave

  • andy kelly

    nah lab are crap too seemingly……society needs to totally readdress care of the older demographic and do it in a much more human manner, thats all Im saying. I get emotional about it as I’m sure my late Mother was on it. Anyhow at least shes out of her suffering now. Sometimes the past is best left in the past.

  • It is patently obvious to anyone who can read and write that the NHS is unsustainable. Third world health care at first world prices. Because there is no direct payment NHS users are treated like ungrateful scroungers who should shut up and be grateful. The sooner this old socialist relic is broken up and moved into the private sector the better. We might get treated like customers then. Privatisation would force people to make some adult choices: what shall I spend my money on? satellite TV, foreign holiday, new car, designer clothes – or health insurance?

  • mrsjosephinehydehartley

    If it’s true this particular NHS chief executive can ” think like both a patient and a taxpayer” then could he tell head teachers what to do, please?

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