Simon Stevens' switch to NHS 'is like Arsenal signing Mesut Özil' he man who helped orchestrate New Labour's massive NHS investment is seen by many as the right choice for the job.
The unveiling two days ago of Simon Stevens as the new chief executive of NHS England prompted widespread relief, a broad consensus that he is the right choice and, in some quarters, an almost desperate desire for him to succeed in what is one of the toughest jobs in public life.
Partly, of course, that is due to the man himself. He may have worked in the United States for the last nine years for the private health firm UnitedHealth, but the 47-year-old is respected and remembered both at Westminster and inside the NHS for helping to orchestrate New Labour's huge investment in the service in the early part of the last decade, which rescued it after years of neglect and decline.
Yet it is also a recognition that, with an ageing population and inexorable increase in long-term conditions, such as obesity, threatening bankruptcy and even its very existence as a unique way of caring for a population's health needs, the institution Nigel Lawson dubbed the closest thing Britain has to a national religion may soon need to be saved yet again.
Sources close to the appointment process say that, despite the number of other candidates with decent credentials, Stevens was always, by some distance, the first choice of David Cameron as well as the chairman of NHS England, Sir Malcolm Grant. Indeed, the prime minister was so keen to lure him that he personally lobbied him to apply at a recent meeting in Downing Street that he instigated for that purpose.
That kind of political support may well prove invaluable. Stevens succeeds Sir David Nicholson, who lost the confidence of ministers in the face of a media storm over his handling of the Mid Staffordshire NHS care scandal, with the Daily Mail's repeated "Man with no shame" refrain particularly hard to live down.
But Cameron's intervention is also surprising: a Conservative prime minister has hired a man who advised Labour's first two health secretaries, Frank Dobson and Alan Milburn, before assisting Tony Blair in Number 10 – a decision viewed by some as a refreshing victory for dynamism over partisanship, but with suspicion and alarm by others.
The Health Service Journal, the bible of NHS managers, said: "It is hard to think of anyone who has the mixture of experience, knowledge and nous that he combines." Its editor, Alastair McLellan, cited Stevens's skillset but also his key role in producing the NHS Plan in 2000 which tackled waiting times, aimed for better outcomes from treatment, and "saved the NHS from sliding towards irrelevance and potential failure".
Mike Birtwistle, a well-connected health lobbyist, is more upbeat still: "He is as near to an A-lister as you get in health management. Forgive the football analogy, but this is like Arsenal signing Mesut Ozil," the richly-gifted German midfielder who has visibly helped the north London side raise their game since joining two months ago. With an American wife, two school-age children, and happily settled in Minneapolis, Stevens had to be persuaded to apply. Roy Lilley, a sharp critic of the coalition's shake-up of the NHS, whose blogs are widely read by service bosses, quipped that Stevens – a friend – was "coming back to a pay cut, a non-job, the mother of all messes and rotten weather".
The £211,000-a-year salary Stevens was offered is well short of his UnitedHealth salary. He took a voluntary 10% cut, leaving his gross pay at £189,900, to reflect the serious financial pressures on the service. It was a characteristically canny move that may endear him to the NHS's 1.3m staff, many of whose earnings have fallen during austerity.
Stevens joined the NHS in 1988 as a graduate trainee after leaving Balliol College, Oxford. He worked as a manager in different settings across the service for nine years, including at a mental hospital in the north-east, before moving into government.
Not everyone is happy about his appointment. Dr David Wrigley, a GP in Lancashire, uses stronger language still, condemningcondemns his appointment as "disastrous. He is a privateer and architect of New Labour's opening up of Pandora's Box to the private health sector."
Dr Richard Taylor, the former independent MP turned co-leader of the nascent National Health Action Party, said: "I fear his appointment could be another nail in the coffin of the NHS as we have known it and loved it."
He recalls Stevens's role in Labour's use of privately-run independent sector treatment centres (ISTCs) to help clear the backlog it inherited of patients needing elective surgery, and his support for Andrew Lansley's NHS restructuring. "I fear he will be right behind the moves to privatisation, however much he asserts he believes in the NHS."
Nor is he afraid of challenge and reform. Matt Tee, who worked with him at Guy's and St Thomas's hospital trust in London in the mid-1990s, and is now chief operating officer of the NHS Confederation – the service's CBI – says his friend embraced ISTCs not just to give the NHS extra capacity but also to spur it to become more efficient. "Simon had no reluctance about using the private sector to tackle those waiting lists, though equally he is also not a slavish believer in the private sector as always being the right thing. To him, it's about getting the outcomes you want." He and Milburn had embodied the prevailing Blairite "what[ever] works" philosphy.
Andrew Harrison was Milburn's special media adviser while Stevens performed the same role on policy matters. Harrison recalls his former colleague's role in laying the ground for the creation of the National Institute of Health and Clinical Excellence (NICE) and what is now the Care Quality Commission regulator, and shifting power from the Department of Health (DH) to semi-autonomous foundation trust hospitals. These moves were controversial, but widely recognised as beneficial.
"During his time in DH he was known as 'the second secretary of state' because so many decisions needed his sign off," says Harrison.
Nine years working for UnitedHealth, first as president of its European arm and most recently as president of its global health division, have strengthened his reforming instincts. For example, he is an advocate of local pay in the NHS.
One option is that he could join forces with hospital trusts to introduce that, to try to stop staff costs consuming 70% of the NHS's £100bn budget, to free up funds for the rising demand for its services. Health unions would fight that.
He believes that competition between hospitals drives up standards. And he has suggested that the NHS could get its own equivalent of Michael Gove's free schools in the shape of independent GPs who would compete with existing surgeries for patients. "Simon is wedded to NHS principles and will know where the heath service is excellent. But he will also be unsympathetic to the areas in need of reform, and bubbling with new ideas for how to achieve change," says Harrison.
The new NHS set-up is supposed to mean the health secretary is no longer in charge of everything and NHS England has much power. But in fact, the health secretary Jeremy Hunt, a contemporary of Stevens's at Oxford, is exerting increasing control. Stevens may be valued by Cameron but he will still wield a lot less power than his predecessor.
Will he be the NHS's man or the government's man in the NHS? Chris Ham, chief executive of the King's Fund health thinktank, says Stevens will have to tread a fine line between responding to an increasingly hands-on health secretary as the 2015 election approaches and collaborating with his counterparts at the other organisations – the CQC, the sector regulator Monitor, the Trust Development Authority and the DH – which are all key NHS players.
His leadership style will be far removed from Nicholson's "command and control" model. He prefers to win an argument by persuasion and bring people with him, says Harrison – which will be a refreshing change for bosses of NHS organisations used to endless diktats from Nicholson, the micro-manager. When the news about Stevens was announced, Roy Lilley rang his "dazzingly bright, decisive and self-assured" friend to ask him why he was taking the job given that "the NHS is running out of money and everyone is running out of ideas about what happens next".
The new man's answer? "He said the NHS was where he started, where he learnt his management skills and where his heart is. He knows it is in a mess and he is prepared to uproot his family, come back and try and sort it out."
Potted profile
Age 47
Education St Bartholomew's comprehensive school, Birmingham, Balliol college, Oxford, Strathclyde university, Columbia School of Public Health
Family Married with two school-age children
Career After a brief post-university stint working in Guyana, Stevens returned to Britain to become an NHS graduate trainee, starting off managing a psychiatric hospital outside Newcastle. After managing numerous hospitals, and a spell at New York City's health department, from 1997 to 2004 he was policy adviser at the Department of Health and Tony Blair's health adviser. He is currently president of global heath at the US giant UnitedHealth.
High point As a senior adviser he helped shape huge changes to the NHS little less than a decade after he joined the service as a graduate trainee.
Low point In an interview Stevens said the government was too timid in areas like the smoking ban and junk food in schools, and should have been much tougher over NHS pay.
What he says "Despite the relative absence of financial barriers, NHS care is still skewed by class, ethnicity, gender and geography. So we don't start from a position of high equity and low choice; we start from a position of partial equity and class-based choice."
What they say Opinion column in the Health Service Journal: "Stevens has got a better chance of leading the NHS towards a sustainable future than anyone else. Given that he has already done so much, success would make him one of the most important figures in the NHS history." The Guardian
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