Reading between the lines, the PM and the Daily Mail have it in for NHS boss Simon Stevens


The Mail Online, 20 November

There’s an astonishing story in the Daily Mail today. It says Downing Street is “gunning” for Simon Stevens, the chief executive of NHS England.

The paper says Theresa May is furious for “telling MPs that the Prime Minister had exaggerated the amount of extra money promised for the NHS” while appearing at a health select committee hearing.

Specifically, it claims Stevens annoyed the PM by telling the committee she was wrong to say the NHS would get “an extra £10 billion a year between now and 2020-21 – up from the £8 billion promised by former Chancellor George Osborne.”

Also, that he’s seen as stepping out of line by making a bid for more money, ahead of this week’s Autumn Statement on Wednesday.

The story may be true

There doesn’t seem to be any reason to think this story is not true. The paper likes May much more than her predecessor, David Cameron, and she has gone out of her way to support its line on, say, Brexit.

So the remarks as reported are likely to have been made. What’s astonishing is that Stevens didn’t say what the paper/Downing Street claims that he said.

NHS finances are complex, and set out in the blog post directly below this one. The basics, however, are that Stevens drew up a plan in 2014 that said the NHS was facing a gap between funding, demand and costs of £30 billion.

He reckoned it could make £22 billion of efficiency savings, with a lot of change, and a following wind, leaving the government to come up with £8 billion. Osborne duly obliged, claiming in last year’s budget that he was “fully funding” what he was quick to call “the NHS’ own plan.”

Things then get complicated because various ministers have claimed the government is in fact putting in £10 billion; counting an additional £2 billion Osborne had already announced for 2014-15.

The health committee reckons it is actually putting in £4.5 billion, because £3 billion is being transferred from the budget for things like running the Department of Health and public health. And one think tank reckons it should be as little as £800,000, because the Treasury has done some creative accounting on inflation and dating.

The health committee went into all this; and Stevens had to confirm the £10 billion to £8 billion and £8 billion to £4.5 billion figures.  He didn’t make the claim attributed to him today. At most could be accused of being forced to do maths in public.

Certainly, journalists have since asked May to do the same kind of maths, and she’s found that embarrassing. But that’s another issue.

The ‘facts’ are not

Stevens did tell an earlier public accounts committee hearing that the money was not being phased in as he asked, and that public health and social care spending had not held up as his modelling demanded. Which raised eyebrows among mandarins and policy wonks.

But he has absolutely not made a public bid for more money. In fact, he almost certainly wants to avoid any suggestion that there may be a bail-out on the way for the acute sector (hospitals), which overspent by £2.4 billion last year, and have been told to accept swinging ‘control targets’ to avoid a repeat this year.

Any hint of a bail-out would make hospitals and their commissioners less inclined to get into the difficult business of change that is being proposed by the sustainability and transformation plans that are supposed to turn Stevens’ ‘Five Year Forward View’ into local action.

As set out directly below, there are plenty of indications this project is not going well, but Stevens does not want it being derailed from the start. Also, when asked a direct question at the health committee, he said that if there was any money going this autumn it should go into social care, which has a financial crisis all of its own.

Ok, what’s the alternative?

The other reason that the Mail’s story is astonishing is that it’s hard to imagine who May thinks is going to take over from Stevens if he goes. Stevens was a Labour advisor at the turn of the century, but when he was recruited to take over from Sir David Nicholson he was working at United Health in the US.

It’s safe to assume that he took a massive pay cut to come back to England. In doing that, he also took on a job that amounts to trying to persuade the NHS to sort out a financial crisis that Nicholson warned it about in 2008 and that it largely failed to tackle.

Stevens isn’t as well-loved as Nicholson, and he can address conferences like he’s read too many management consultant text books in airport lounges, but he must really believe in the health service to have taken on the challenge.

If May and her advisors think there are loads of candidates willing to step into Stevens’ shoes, they are likely to find they are wrong. Indeed, before this morning’s intervention, the general assumption was that the government would be only too keen to keep Stevens in place.

Trotting out Osborne’s “NHS’ own plan” line gives ministers cover whenever there is a suggestion that the health service might fall over this winter, prove to be financially unsustainable in the long-term, or need to get rid of a lot of ageing, clinically unsafe, but much loved local hospitals.

Indeed, MPs on the health select committee have tended to express a cack-handed kind of sympathy with Stevens; asking if he is being set up as the “fall guy” for when the Forward View fails to deliver, as some unhelpful voices are starting to say it will.

Meantime, Labour moans that Stevens is covering for the Tories’ failure to spend adequately on the NHS, that he really wants to make cuts or that he wants to privatise large chunks of it (and yes, the last two are contradictory).

Worrying… on so many levels

We have to hope that May and her advisors know the facts, and were simplifying for effect in their comments to the Mail. If that’s the case, what are we to make of the story?

One interpretation would be that we have a Prime Minister who is so thin-skinned that she is prepared to lash out at a civil servant for answering Parliamentary questions, if this in turn makes journalists ask her difficult questions. This would not be good.

Another is that Downing Street realises the NHS is in deep trouble, that the government is going to have to find more cash for it or face protests on the streets (or both), and that it’s getting its retaliation in early by setting the press pack against the man in charge.

This would be worse. Any check on the Forward View and its STP process will make it less likely to succeed, when the odds are turning against it anway. And one thing we can be sure of is that the government has no alternative plan; and no capacity thanks to Brexit to develop one.

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