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The new NHS England chief executive knows he can make a difference

Alastair McLellan
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In HSJ’s in-depth interview with Simon Stevens, the NHS England chief executive demonstrates that the service is always evolving and gives an indication of where he plans to make his mark

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Simon Stevens’ first interview as NHS England chief executive is all that you would expect: clear sighted, measured and very careful not to be painted into any corners. But read closely and some powerful themes present themselves.

His view of clinical commissioning groups emerges as one of positive, but arm’s length, encouragement. They are doing well but still have to prove themselves.

As he often does, Mr Stevens refers back to the history of the NHS, to show that the service rarely stands still. CCGs, he notes, can be seen in two ways: as organisations with a track record measured in months or as the latest stage in the 23-year history of getting primary care clinicians involved in commissioning.

He sees CCGs as an important stage in that journey; but were commissioning development be represented by the famous Rudolph Zallinger illustration of evolving mankind he would probably tag CCGs as “Neanderthal” or “Cro-Magnon” rather than “modern man”.

Charged political atmosphere

Mr Stevens is careful to stress that his boldest ideas have a “three to five year” timeframe and that he expects the drive for new approaches to come from local commissioners and providers rather than NHS England. He is keen to note his role is to give CCGs and others “permission” to try “something different”.

However, he is unlikely to remain patient if he perceives the service is dragging its feet and he will also bear down on barriers to change. The statement “attaching staffing to our bricks and mortar and traditional ways of doing things has got us to a very ossified set of services” is the first shot across the bows of those he perceives too wedded to outdated models of care.

‘Simon Stevens’ ideas will give politicians of all parties desperate for something new to say on the NHS material for manifestos’

Acutely aware of the charged political atmosphere, Mr Stevens makes the point that “the elected government gets to decide the broad thrusts of [NHS] policy”, but he expects to be first among equals when filling in the detail.

Any incoming Labour administration, for example, would, judging by this interview, be cautioned against the removal of competition as a commissioning lever, the installing of NHS organisations as a preferred provider or giving health and wellbeing boards too much power, too early.

Likewise, Conservative health policymakers will be told that a policy that hammers “failing” NHS providers without taking into account the pressures imposed on them by “pressurised health economies” and seeking system-wide solutions in response might be good press, but makes bad policy.

Privileged situation

But Mr Stevens’ ideas will also give all parties material for manifestos that would carry the support of the service. His plans could easily accommodate a gradual shift to combined health and social care commissioning, for example, or more market minded.

‘The new chief executive understands, probably better than anyone who has held the service’s top job, what difference he can make’

The new NHS England chief executive understands, probably better than anyone who has held the service’s top job, what difference he can make, as well as how and when to make it. .

At present Mr Stevens has little skin in the game; he can stand back and critique a system that he knows is fundamentally flawed in some areas, as well as significantly advantaged in others. This privileged situation will probably last for the next 12 months. This interview gives us the first in-depth look at where Mr Stevens will eventually plan to make his stand.

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