Runners and riders for Britain’s fourth most important job: running NHS England

Wanted: man or woman with the hide of a rhino and nerves of steel to run a national healthcare service spending £212 billion or so a year, employing 1.3 million people and treating one million patients every 36 hours.

The job: to be the next chief executive of NHS England, taking over from Sir Simon Stevens who steps down at the end of next month.

After the Prime Minister, the Chancellor and the Governor of the Bank of England, the role is arguably the fourth most vital in the country. Such is the quasi-religious status given to the UK’s health service, whoever takes on this role has to be mother of the nation as well as being a visionary of what healthcare might look like in 20 years’ time. And knows how to implement that vision.

With only a few weeks to go before a decision is due to be signed off, the interviewing of candidates by the NHS England board is reaching the final stages.

Who then are the favourite runners and riders? Perhaps more pertinently, what sort of person can fill the enormous requirements and responsibilities of the role?  The NHS is already Britain’s biggest employer – and the world’s fifth largest – and is set to become even bigger as services are expanded to meet an ageing, and therefore, less unwell nation.

Over the last year alone the NHS England budget was increased by £62 billion to help fund the extra cost triggered by the pandemic such as the procuring of PPE, developing Test and Trace and the vaccination programme. That’s on top of the £150 billion spent in 2020 on running the normal day to day work which includes the ambulance, community, mental health, and hospital services and clinical commissioning groups.

Is it a classic CEO role for someone with great delivery and business management skills or does the position require a medical visionary who has distinct ideas for the future of healthcare systems in a post-Covid world? Or a mix of both ?

Stevens’ background may give some clues to what the NHS England board will be looking for in the potential candidate. Joining the NHS in 1988 as a graduate trainee, he went up through the hierarchy managing hospitals on the front-line.

But he also dipped into policy-making, having worked as an adviser to former prime minister Tony Blair and was one of the architects of Labour’s health reforms. He then left the UK in 2004 to work for the US private healthcare group, UnitedHealth.

Appointed by David Cameron in 2014, Stevens is viewed as a “reformer and an innovator”, someone who has pushed for modernisation through the adoption of digital and other new technologies to improve services. Some claim he has been the greatest influence in the NHS since Aneurin Bevan, while his critics argue he set off the trigger for privatisation through the backdoor.

The two favourites to replace Stevens are his number two, Amanda Pritchard, who is chief operating officer of NHS England and chief executive of NHS Improvement and Mark Britnell, chairman and partner of the Global Health Practice at KPMG.

Pritchard is said by insiders to be in pole position to take over from Stevens. Still in her early 40s, she is clearly a high-flyer. After school in Durham, she read modern history at Oxford before joining the NHS graduate training scheme. Aged 29, she was appointed deputy chief executive of Chelsea and Westminster Hospital.

A few years later, she became chief of Guy’s and St Thomas’ Foundation Trust before being parachuted into the top NHS role a few years later. She found time to serve as health team leader in the Prime Minister’s Delivery Unit.

According to HSJ healthcare magazine, Pritchard has earned plaudits during the crisis by staying cool and focusing on policy details while Stevens did the big picture stuff. Medics rate her too, saying that promoting Pritchard would provide continuity during such a troubled time. A comprehensively educated mother of three from the North would also show levelling up is not just a gimmick.

Another strong contender – though an outsider – is Mark Britnell who heads up the healthcare practice at KPMG. Britnell is considered top of class, having run a teaching trust and worked for the Department of Health, giving him a good inside track into government. Since then, he’s worked at KPMG at an international level so understands how different health systems work – and don’t work – around the world. That’s not a bad experience for a NHS chief to have in a world that is going to be dominated by crisis-management and new pandemics for the foreseeable future. But the government might find it tough to withstand criticism that it is appointing a “consultant”.

There are another eight or so highly talented candidates in the field who include Sir James Mackey of Northumbria Trust, Sir David Sloman, NHS regional director for London, Julian Hartley of Leeds Teaching Hospital, Dame Alwen Williams of Barts and Sir Mike Deegan of Manchester University Trust, said to be a huge brain who has worked miracles in one of the country’s toughest regions.

Making the hard choices is the NHS England board which includes eight non-executive directors who are big-hitters from the commercial and medical worlds. Chaired by Lord Prior, they include vice-chair David Roberts, the Nationwide chairman, and ex-Lloyds and Barclays director, Professor Lord Ara Darzi, director of the Institute of Global Health Innovation at Imperial College London, Mike Coupe, ex-Sainsburys’ boss and Laura Wade-Gery, chair of NHS Digital having run Tesco.com.

Whoever is recommended by the board for the top job would be approved by Matt Hancock’s Department of Health and Social Care. But the health minister’s own position is in the firing line following accusations by Dominic Cummings that he lied about whether patients were being tested before being transferred from hospital to care homes. Insiders
also suggest he has fallen out big time with Stevens.

With the running of NHS England more critical than ever, it’s likely the shortlist will be scrutinised by Cabinet ministers with the Prime Minister taking more than a passing interest. Protecting the NHS has been at the forefront of government policy dealing with the pandemic, some might say obsessively so.

Yet the way the virus has hit ripped through certain specific parts of the population has exposed this country’s widening health inequalities, particularly marked on a regional basis. This means that whoever becomes the new NHS England chief executive must take charge of a new strategy which helps prevent many of the chronic illnesses which so many of the most economically deprived suffer from.

Longer term, the most superior way to protect the NHS is to improve the nation’s general health – treating obesity and diabetes with better nutrition and education rather than pills for example – and flip the National Health Service into a National Wellbeing Service.