It hardly needs saying that the appointment of a new chief executive to run NHS England is an enormously important moment. Sir Simon Stevens has run the service for seven years and his departure coincides with a shake-up. His successor will be a less powerful figure, who stands, in an upcoming health bill, to be stripped of the independence granted as part of the last round of Conservative reforms.
Giving control back to ministers was always a questionable move, particularly given the government’s record during the pandemic. Circumstances surrounding the departure of Matt Hancock have heightened concerns about cronyism. But the prospect of the service’s new boss being chosen by a newcomer, Sajid Javid, does not inspire confidence either (the task is undertaken jointly with NHS England’s board). At a time of great peril for the service and the 56 million people who rely on it (just 11% of the UK population are thought to have private health insurance), the situation is chaotic, with health minister Lord Bethell also facing questions about why he sponsored Gina Coladangelo for a parliamentary pass.
It is hard to exaggerate the risks now facing the NHS. The British Medical Association said of Mr Javid that he faced “probably the most daunting in-tray that any secretary of state for health has ever inherited”. Waiting lists for hospital treatment have grown to 5.1 million, a backlog that will take years to clear. Key decisions remain to be taken about the UK’s vaccination programme, including whether to vaccinate children and how to deliver booster shots. The failure of three successive Conservative prime ministers to legislate on social care funding has been a dereliction of duty. Workforce problems in some areas are acute, with nurses warning of strike action if a 1% pay offer is not improved.
Research this week by Sir Michael Marmot, a leading public health expert, showed the grim extent of regional health inequality. He described recent falls in life expectancy in Greater Manchester as “jaw-dropping”, and warned ministers that their “levelling up” agenda will fail if it ignores health. NHS England needs a new boss who is equipped to heed such warnings, and support local systems to tackle deeply embedded problems. Last year’s decision to disband Public Health England has already created needless disruption.
Amanda Pritchard and Sir James Mackey look like the strongest candidates. Ms Pritchard is the current chief operating officer, and previously led Guy’s and St Thomas’ NHS trust. Sir James is chief executive of Northumbria NHS trust, and ran NHS Improvement before that. Dido Harding, by contrast, is singularly unsuited to the role, lacking relevant experience. Given this, and the grave shortcomings of the UK’s test-and-trace operation that she headed, it is difficult to see why her application was looked on as favourably as it seems to have been.
The government is already under pressure on its approach to appointments, as well as outsourcing contracts. Peter Riddell, the commissioner for public appointments, has criticised decisions taken “without competition and without any form of regulatory oversight”. Lord Evans, chair of the committee on standards, has called for a strengthened watchdog. In this context, the process of replacing Sir Simon can be viewed as a crucial test. Mr Javid and his NHS partners must make the health and wellbeing of the public their primary consideration, and give an expert the job.
