A perfect storm

After months of speculation, NHS England has a new chief executive. Sir David Nicholson’s replacement is Simon Stevens, and his impressive track record and a blend of national and international experience made him a strong candidate from day one. However, much of the debate to date seems to have focused on appointing a new NHS Chief Executive – and yet the role as Chief Executive of NHS England is arguably very different. Heading up an arms-length commissioning board may involve trying to respond to the (sometimes short-term) wishes of ministers whilst also retaining enough critical distance and doing what is right for the NHS in the long-term. This is likely to be a tricky balance to strike – particularly in the run-up to a general election where the performance of the health service will be a critical issue. The new NHS system could also be very fragmented, and it will take significant leadership to build a common vision and hold together a group of – potentially quite disparate – new national bodies. Any incoming Chief Executive that tried to do this through positional authority alone might quickly find that they don’t have as much as many people think. Simon Stevens’ track record here with the narrative that was crafted for the 2000 NHS Plan and the consensus that was built around the need to ‘modernise’ the NHS may be a really positive sign.

Of course, the appointment comes at a very challenging time for the NHS, with high profile media and public questions about the quality of care we deliver prompting significant soul-searching. Some NHS staff no longer feel able to be proud of what they do, and the service as a whole faces a major crisis of confidence. Preventing bad care whilst also supporting staff to deliver really good care will be difficult but crucial. All this also takes place with new Clinical Commissioning Groups still on a steep learning curve, major tensions in A&E departments and a number of hospitals across the country unlikely to prove financially viable in the current policy context. Add this to very difficult NHS finances and draconian cuts in local government, and the stage seems set for a perfect storm.

However, all these challenges are also opportunities. Ironically, the challenges are so severe that major change – only ever talked about before – might well be needed. Policy makers have long emphasised the need to develop more community-based approaches for people with long-term conditions, to reconfigure some hospital and specialist services, to end the health and social care divide and to put more power in the hands of patients and their families. While the current context is incredibly challenging, it may be that some of these aspirations have to become realities because doing nothing will not be an option. Perhaps a perfect storm could also be a perfect opportunity to do something genuinely different?

Jon Glasby is Professor of Health and Social Care and Director of the Health Services Management Centre at the University of Birmingham.