So, Simon Stevens has got the top job in health – chief executive of NHS England, the organisation that is meant to run the new planning and purchasing (“commissioning”) set up created by the last health secretary, Andrew Lansley.
I wrote a news story for EHealth Insider, outling his background. Since then, the Health Service Journal has gone overboard in its praise. But Stevens is going to be a controversial appointment; not only because he has been working for UnitedHealth for a decade, but because he was closely associated with the Miliband / Blair reforms of the early 2000s. These reinvigorated the ‘internal market’ Labour had promised to abolish before the election in 1997.
Since Lansley got the Health and Social Care Act 2012 through Parliament, it’s been an open question whether the NHS will respond to the pressures on it at the moment by creating more streamlined, co-operative services or by trying to create more competition in the hope of driving less efficient services out of business and encouraging the survivors to try harder to win patients with higher quality services.
While the new clinical commissioning groups have been settling down, the focus has been on the former, with the government talking about ‘integrated care’ (linking hospitals, GPs and even social services) and allowing some local reorganisations to proceed (to the fury of the competition authorities, in Bournemouth and Poole, at least).
Stevens’ appointment suggests that the focus might now switch back to the competiton elements of the reforms. This will be popular with a good chunk of the Conservative party, its supporters in the press, and companies hoping to cash in – including his old employer. Yet, as the BMA and some think-tanks keep trying to point out, there is little if any evidence that market-based reforms have done much except increase costs.
And Stevens himself has hardly benefited from them until now. He quit the UK for the US in 2004, as another round of new commissioning bodies struggled, and a financial crisis was on the horizon. And United Health UK, which set up a few years back in the hope of winning chunks of profitable GP and commissioning work, has just given up and rebranded itself. Which hardly inspires confidence.