Simon Stevens: a new Chief Executive of NHS England

The Chairman of NHS England, Sir Malcolm Grant, announced the appointment of Simon Stevens as the new Chief Executive of NHS England on 24 October 2013.

The Secretary of State for Health, Jeremy Hunt, was quoted as saying that Stevens would 'make a key contribution to the two biggest challenges facing the NHS right now: how to raise standards of care and also be financially sustainable. His passion for our universal health service free at the point of use goes back many years, but he will add international expertise as we face the challenges ahead'.

Stevens started his new role on 1 April 2014. On his first day as Chief Executive, he made a speech in Tyneside, where he had begun his career in the NHS 26 years earlier. He stated that: 'Service pressures are intensifying, and longstanding problems are not going to disappear overnight. As my predecessor David Nicholson has pointed out, this year is going to be a challenge and 2015/16 even more so. No one person can fix everything that needs fixing - certainly not me. Successfully navigating the next few years is going to take a team effort - involving the biggest team in the biggest effort the NHS has ever seen'.

In subsequent announcements and interviews, Stevens suggested that he would take a 'pragmatic approach' to competition and that he did not share his predecessor's (Sir David Nicholson's) concerns that competition law was a barrier to health service reform.

On 1 May 2014, he also announced plans to allow clinical commissioning groups (CCGs) to co-commission primary care. NHS England wrote to CCGs on 9 May, outlining further details of the proposed scheme. The letter invited CCGs to submit expressions of interest for expanded commissioning powers. In their bids, CCGs would be expected to detail what extended powers they wanted to assume and how they would be beneficial. They would need to demonstrate how they would promote integration, reduce health inequalities, involve patients and the public, and raise standards.

On 4 June 2013, in a speech to the NHS Confederation annual conference in Liverpool, Stevens outlined his vision for the NHS: 'NHS commissioners exist to unleash more health and care bangs for the buck. To drive greater value than would be obtained from just perpetuating the status quo. Talk to the public and to patients - as I've been doing around the country - and there's quite wide agreement about what our fellow citizens want from the NHS. It's neither surprising nor unreasonable - which doesn't mean it's easy or inevitable. Our neighbours, relatives, colleagues want reassurance that care will be readily available when it's needed. Care that'll be safe, treatments that work, services where the left hand and the right hand know what they're doing. Staff who always take patients' dignity and preferences seriously. Care that is fair and non-discriminatory and non-wasteful. In short, an expectation that all of us who work in the NHS will think like a patient and act like a taxpayer.'

He acknowledged the growing and significant challenges facing health and social care, but felt that 'necessity truly is the mother of invention' and set out three ways in which NHS leaders could help to improve care:

1. Improving commissioning – he suggested that commissioners were central to delivering positive outcomes for patients. To assist commissioners, NHS England would look into increasing the use of payments to providers to incentivise and reward quality improvement. However, NHS England would undertake a 'hard-nosed' review of all incentive schemes in place, including quality premiums. NHS England and Monitor would look into possible changes to the payment system and new models of reimbursement.
2. Redesigning care services, giving maximum flexibility to local health and social care to meet needs – Stevens suggested that progressing changes in care delivery needed to be prioritised over reforms to management structures. He pushed for evidence-based commissioning and policy making, and emphasised that the focus on merger and centralisation was not necessarily the best approach in all circumstances, highlighting the benefits of small hospitals.
3. Taking advantage of the new innovations and developments in modern medicine – Stevens suggested that England, like other industrialised countries, was on the cusp of three fundamental shifts in medicine, namely:
   1. personalised medicine and the development of biomedicine
   2. the use of data to improve transparency and quality
   3. the potential for individual patients and communities to play a greater role in controlling their own health.

Against a trend of promoting consolidation and centralisation, Stevens appeared to be an advocate for smaller hospitals where appropriate. He suggested that England had quite concentrated acute services, with a stronger degree of regionalisation compared to many other western countries, and that England's 'small' hospitals were not really that small.