Simon Says Yes

And so Simon Stevens, the global president of an American private healthcare firm, is to be chief executive of NHS England. Stevens is currently President of UnitedHealth’s Global Health division. The American Association for Justice – an international coalition of attorneys and law professors promoting a fair and effective justice system – ranked UnitedHealth as the eighth worst insurance company in the US. ‘Plagued by accusations that its greed has endangered patients. Physicians report that reimbursement rates are so low and delayed by the company that patient health is compromised. Money that should have been spent on medical treatment for policyholders has instead gone to the company’s former CEO, who faced criminal and civil charges for backdating stock options’1 One of Steven’s many challenges will be to prove the NHS is not going to be carved up for corporate profit. He has to be trusted to act in the best interests of patients.

UnitedHealth UK could certainly do with a boost. It recorded a £8.2m loss and a 27 per cent fall in turnover in 2012 – its eleventh loss-making year in a row. UnitedHealth Group is set to wind up its loss-making UK arm and ‘shift staff into another subsidiary with a more pan-European focus’. The Heath and Social Care Act certainly gives the private sector more opportunity to bid for NHS contracts, and with their corporate muscle they stand a good chance of winning them. But as UnitedHealth and others have found, there’s precious little profit in the NHS at the moment. Stevens knows this, and has voluntarily taken a 10% cut in the NHS CEO salary to £189,900.

Stevens also knows the NHS well. He was a Labour councillor, spent nine years working in the NHS and in 1997 became Frank Dobson’s and then Alan Milburn’s chief advisor, before becoming Blair’s health policy director. Stevens was one of the authors of Labour’s NHS Plan, which was accompanied by a huge increase in NHS funding. There were some notable improvements – huge falls in waiting times for treatment, improved performance by A&E units, better outcomes for patients with cancer and heart disease – but there were also huge missed opportunities. Productivity hardly budged for all the extra money, scandals passed unnoticed, the promised IT system that would link up the entire NHS and give patients control over their records never materialised, and vital reorganisations of specialist care into fewer, safer, better-resourced centres didn’t happen.

MD met Stevens when he was Dobson’s adviser to discuss the Bristol heart scandal. The fact that child heart surgery still hasn’t been safely reorganized 16 years on is deeply troubling, and the NHS is only now starting to publish outcomes and patient experiences to prove which services do more good than harm and to guide patients where to go (should they wish to travel).

Stevens’ biggest challenge will be to end the culture of bullying, blame and fear in the NHS. This will not be easy in the run in to an election, with Hunt already accused of tweet-libel by Burnham and Burnham threatening to sue. This week, Professor Steven Bolsin was finally honoured by the Royal College of Anaesthetists for his courageous whistleblowing in Bristol over 20 years ago. Meanwhile, the tribunal of whistleblower Dr Raj Mattu v University Hospitals of Coventry & Warwickshre NHS Trust (Eyes passim), looks set to become the most protracted, divisive and expensive in NHS history. Whistleblowing Alder Hey surgeon Ed Jesudason (Eyes passim ) has sent his evidence to the Public Accounts Committee and the CQC, and whistleblowing Walsall paediatrician David Drew (Eyes passim ) is publishing a truly shocking book to get his story out.

These doctors are not mad, just brave people who tried to speak the truth to power about patient safety and had their NHS careers destroyed. The Nursing Times has started a brilliant Speak Out Safely campaign to support frontline whistleblowers but less than 50 Trusts and CCGs have signed up to it. Stevens knows that the chief executive of NHS England has surprisingly little power to influence care on the ground. But he must try to ensure those of the front line – patients, carers and staff – feel safe to speak up, stop harm and finally make the NHS transparent about its failures, as well as its successes.

1 http://www.justice.org/cps/rde/xbcr/justice/AAJ_Report_TenWorstInsuranceCompanies_FINAL.pdf