I just became aware, incidentally, that the former head of NHS England, Simon Stevens is now both a Lord (which apparently is odd by itself) AND he is a former Labour councillor for Angell Ward - of the 98-02 cohort.
Interesting career he's had. Don't jump the gun - he will not be a Lord until his retirement as CEO on 31st July.
What a pity I didn't meet him when he was my ward councillor!
This appreciation in "The Lancet" in 2014 gives some flavour of the man, or at least his sales prospectus:
From the moment David Nicholson stepped down as Chief Executive of NHS England, there seemed to be only one name in the frame as his successor. Yet Simon Stevens, then president of the global health division of United Health in the USA but a decade earlier policy adviser to Labour Health Secretary Alan Milburn and Prime Minister Tony Blair, might on paper have looked like a problematic choice to take charge of that most publicly beloved and politically sensitive of institutions, the National Health Service (NHS).
But his reputation was such that the job was his to turn down, which some might have expected given the challenges facing the NHS and his successful and settled life with his family in the USA. After leaving Oxford and Strathclyde universities, and with a year's break as a Harkness Fellow in the New York State Health Department, he spent 15 years in the NHS—“my heart is in the NHS”, he says—and in UK public services. The past decade, working internationally, has been enjoyable, he says, “but I think there was a sense that the NHS is at a defining moment and so, given I care a lot about the NHS and love a challenge, in the end I decided yes, I'd do it—with my eyes open, recognising that these are challenging times but I do think it is possible to get it right for the NHS”.
Expectations are unreasonably high, says Chris Ham, Chief Executive of the King's Fund. “I think that's difficult both for him and for the NHS because even with the big brain and the huge effort and the other things that he brings to the job, we're going to face 3, 4, 5, 6 years of huge obstacles…and there's only so much one person can do even if he surrounds himself with some very talented able people.”
Stevens, just a few weeks into the job, is upbeat. Any notion that the NHS is failing is wrong, he says. “The quality of care has probably never been higher. The satisfaction that our patients have is in the zone of being an all-time post-war high. Net public satisfaction with the NHS was around a third in 1983 and is now somewhere between three fifths and two thirds—and we are in year 5 of the longest period of austerity that the NHS has ever seen, so actually it's a huge achievement.” Greater transparency in the wake of the Mid-Staffordshire scandal might expose problems, but that is how you find out what needs to change, he says.
England is, he says, too big for centralised control of health care. His remarks on keeping smaller hospitals open might have made some think reconfiguration was off the agenda, but it's not so. Reorganisation of stroke services has been a success and he believes concentrating trauma into 40–70 centres will be, but one size does not fit all. “I think you can argue there are five or six different care models that might work well in different parts of England and so we're going to be having structured conversations in different parts of the country about which of those five or six local communities and clinicians think would work well and then putting in place the enablers to support that and frankly removing some of the impediments that might exist to that.” We have bounced into a false dichotomy in the UK, he says. “I don't think we have to choose between dirigiste control versus laissez faire.”
Moving care for elderly people into or near their homes is a priority, and will be made easier with technological solutions. “I do think we're on the cusp of something quite interesting, particularly in support for people with multiple chronic conditions, frail older patients, who are the majority of people being served by health-care systems in all advanced industrialised countries.” But he is concerned too to support unpaid carers, who at about 1·4 million outnumber the NHS workforce: “This is about the construction of communities, it's about social capital, it's about the fabric of ageing that doesn't just show up in a hospital inpatient ward. How well we support older people is going to be probably the make-it or break-it test for health systems in all western countries.”
Once a Labour councillor in Brixton, Stevens has not been a member of a political party in a decade, but he has a social agenda with health inequalities high up on it. His father was a Baptist minister and he grew up on a council estate, winning his place at Balliol to study PPE from a comprehensive school. After his first job in agro-industrial diversification in Guyana, he joined the UK's NHS graduate manager training scheme and went to work in Consett, where the steel works had shut down and the NHS was the biggest employer. He went back there on his first day as NHS England Chief Executive in April. He has also been back to Birmingham, to visit his old general practice surgery and talk about health inequalities.
Finance must be Stevens' biggest challenge. He is credited with persuading the Blair Government to invest in the NHS. But in the fifth year of flatline funding, changes have to be made in the delivery of health care to keep the NHS on a sustainable financial footing. They will include reducing variations in costs and patient outcomes between institutions, supporting patients and carers in the community to keep them out of hospital, and a stronger focus on the causes of ill health, including smoking, drinking, and obesity. Stevens rejects any suggestion that his time with UnitedHealth has turned him into an advocate of greater privatisation, as some of the unions suggested when he spoke in April of the “innovation value of new providers”. “If I didn't believe in the NHS I would not have uprooted my family and come back here”, he says. “One of the things you learn is that generally speaking, most stereotypes are untrue. There is within each country's health-care system the good, the bad, and the ugly. The key is to differentiate.”
