What's in the new NHS boss's in-tray?


Simon Stevens is starting his first day as chief executive of NHS England.

It marks his return to the NHS fold after a decade with the US firm United Healthcare where he has been overseeing its global arm.

But his appointment to the £211,000-a-year post comes at a crucial time in the history of the health service. So what's in his in-tray?

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Money worries
Piggy bank

The NHS may be one of the few areas of the public sector to have its budget protected - it is rising by 0.1% a year on average in this Parliament - but it is still facing some tough economic choices.

In fact, as the BBC is reporting, Mr Stevens is making money a central theme of his first speech as head of the health service.

He is expected to say navigating the next few years will require the "biggest effort" in the history of the NHS.

It is easy to understand why. The NHS is in the middle of an unprecedented £20bn savings drive.

But it is proving tough going. The early indications are that the hospital sector will finish the 2013-14 year in deficit - the first time that will have happened in eight years.

It means there will need to be some tough choices ahead about what can and cannot be provided.

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Keeping Hunt hands-off
Jeremy Hunt

It is a year since the NHS reforms came into place. One of the stated goals was to give the health service a degree of independence from the secretary of state.

Hence the creation of the organisation Mr Stevens now leads.

But of course the architect of the reforms, Andrew Lansley, is no longer in place and his successor, Jeremy Hunt, seems to have other ideas.

From announcements about financial incentives for trusts to get their staff vaccinated against flu to last week's speech about patient safety when he set out new goals for reducing avoidable harm, Mr Hunt has left himself open to accusations that he is encroaching on NHS England's territory.

Indeed, a recent article by The Guardian accused him of being a "control freak" and "micromanaging" the health service.

It is likely to require all Mr Stevens' political nous to keep NHS England independent while remaining on good terms with his political boss, especially with an election round the corner.

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Spreading happiness
Pharrell Williams

Singer Pharrell Williams may be happy, but for staff in the NHS it seems to be a different matter.

After several years of pay freezes, the government has rejected recommendations that they be given an across-the-board rise.

Instead, ministers announced last month they would only give a 1% pay rise to those who would not get a "progression-in-the-job" increase - about half the workforce.

The move has disappointed unions with talk already turning to industrial action.

This matters because research shows that happy staff provide good quality care.

After the Stafford Hospital scandal, that is the number one priority for the health service.

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Digging NHS England out of a hole
Population graphic

Most people are agreed that the NHS should use the information it is able to gather as a universal, national health system to aid medical research.

But the scheme designed to do just that - the Care.data database - has been mired in controversy.

NHS England was forced to delay its implementation until the autumn after concerns about patient confidentiality and the way it had been communicated.

It will now be up to Mr Stevens to help the organisation find a way out of the mess it has created for itself.

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Putting his own stamp on the system
Hospital bed

In many respects, he arrives at an odd time. NHS England is already a year old and has published proposals for major changes to hospitals (a two-tier system of major and minor units) and weekend working.

Meanwhile, ministers have taken a lead on joined-up care to address the needs of the ageing population (the £3.8bn Better Care Fund will be launched in 2015 to encourage greater partnership between social care and the NHS).

These are arguably the most pressing issues of the time - and it will be up to Mr Stevens to help ensure plans set out by other people are successful.

So how can he make his mark? In terms of hospital reconfiguration and joined-up care, his advantage is that there has been talk for years about how this is needed but little progress.

With money tight, the NHS now has no excuses. If he can make it happen, he could go down in history as one of the great reforming health service leaders.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 29.

    Amazing how many people still think money can be saved by giving power to GPs. Hopefully he will realise, unlike too many politicians, that good companies run through good stable management and solid administration. Don't try and change direction like a drunk driver and don't leave the front line overworked with paperwork saying you are "cutting buracracy" by removing administartive staff.

  • rate this

    Comment number 28.

    @25.presario: "Just looked up Simon Stevens background. Well I never! Another Oxbridge product...What we need is someone from the same mold a Nigel Farage"

    I hate to burst your bubble but Nigel Farage went to a public school and then became a commodities trader in the City of London, okay he didn't go to university, but he's hardly your average Bob on the street is he?

  • rate this

    Comment number 27.

    15. Little_Old_Me
    the NHS is NOT riven with fraud & error (less than other countries systems).


    Of course not. I mean the DoH's official figures for fraud only include that in dental and pharmaceutical services.

    But keeping figures low means counter-fraud's budget stays low and that's good for everyone right?

    Particularly the fraudsters...

  • rate this

    Comment number 26.

    For a prioritising leader, as opposed to a timeserver, the pursuit of health would be publicly recognised as best by a free people, all enabled to compete to be their best, rule in every heart by conscience not fear and envy and greed, the choice of genuine democracy open to us simply through understanding, education and adult agreement; sorry injunction meanwhile, 'Do your best & watch your back'

  • rate this

    Comment number 25.

    Just looked up Simon Stevens background. Well I never! Another Oxbridge product.
    What we need is someone from the same mold a Nigel Farage, someone who cuts to the chase.
    I suspect this guy will simply manage the decline of the NHS and its transition into the private sector.
    That would be a huge shame. The NHS can be saved. Private healthcare would have no goodwill. WHAT PRICE GOODWILL?

  • rate this

    Comment number 24.

    Just another over paid suit in a corrupt and failing institution being ran by unregulated government whips! Vested interest in private health firms throughout the NHS just like the private sector, adhoc-ly, controlling the MOD. It is paid for by the public for the pubic but ran by the government for private investors and disgusting wages.

  • rate this

    Comment number 23.

    So Stevens responsible for competition and PFI's in the NHS under Blair is brought in by the Cons to fix the mess that he created and left to go private. The best April fool yet.

  • rate this

    Comment number 22.

    I started to make a list, but what's the point. They have their own agenda and it doesn't include really taking notice of what people want.

  • rate this

    Comment number 21.

    Majority of NHS savings were supposed to be from transfering to GPs, NHS employees sacked & then many taken back on by GPs for less money.

    Majority of savings, are cuts to people wages, not via improved efficiency.

    I can see Simon Stevens increasing contracted out services as the main driver of any savings, again, good workers sacked & paid off at HUGE costs & then re-employed privately

  • rate this

    Comment number 20.


    I love it, never had a problem, could be better, could be worse, some areas are worse than others, some are better...

    Hey BBC I seem more balanced than your staff can I have a job?

  • rate this

    Comment number 19.

    1) Kick politicians into the long grass and let me run the NHS
    2) Kick politicians into the long grass and let me run the NHS
    3) Kick politicians into the long grass and let me run the NHS
    4) Kick politicians into the long grass and let me run the NHS
    5) Kick politicians into the long grass and let me run the NHS
    6) Kick politicians into the long grass and let me run the NHS
    7) Kick politicians...

  • rate this

    Comment number 18.

    Its only since the old boy network has been put in ( being grossly overpaid of course ) to run it that the NHS has got so bad ... If that money had gone towards paying nursing staff a decent wage it would have been a better idea
    Get those business leeches out and some ground level common sense back and we can sort the NHS out ... Hand it over to this sort and you might as well wave goodbye

  • rate this

    Comment number 17.

    Is this a further attempt to "commercialise" the NHS?
    Having had experience of contracts where it was "suggested " using commercial partners would improve a bid from the NHS trust resulting in a partnership with Take care Now (TCN) (who employed Dr Ubani with fatal consequences) I hope not.

  • rate this

    Comment number 16.

    Question whether your post and salary are necessary. Promote the case for devolving all powers directly to hospital consultants and GPs with the objective of trimming down the health service to the front line staff and the support that staff deems necessary.
    The current Health Service has grown like Topsy and nothing short of revolution will solve the problem. Evolution is not the answer.

  • rate this

    Comment number 15.


    Top of the list should be to robustly expose the LIES of those who would do the NHS down & try to privatise it...

    ...people are not systematically killed by the NHS...

    ...the NHS is MORE EFFICIENT than any other western health system...

    ...the NHS is NOT riven with fraud & error (less than other countries systems)...

    ...the NHS has a (relatively) tiny budget...

  • rate this

    Comment number 14.


    Bit by bit, the key assets of theNHS are being dismantled and being farmed off to private companies. Remember our politicians have no shame only their own personal gain to worry about.

  • rate this

    Comment number 13.

    'It marks his return to the NHS-fold after a decade with the US firm United Healthcare where he has been overseeing its global arm.'

    Nope no conflict of interest here move along move along !!

    Why did he leave the NHS in the first place?

  • rate this

    Comment number 12.

    There will be nothing in his inbox that a serf won't be able to do

    His agenda is what we should be worried about and if it's anything remotely like the US healthcare system then be very very afraid!

  • rate this

    Comment number 11.

    1. Secure golden pension
    2. Obtain knighthood
    3. Do as government says
    4. Show private sector the books
    5. Wrangle seat on the board of private company
    6. Fill in expense forms
    7. Put in for £ million bonus
    8. Job done, time for that family holiday in Florida

  • rate this

    Comment number 10.

    Get it right first time!!


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