UNISON responds to appointment of Simon Stevens as NHS chief executive

UNISON, October 24, 2013

Responding to the announcement that the president of Global Health and group executive vice-president at UnitedHealth, Simon Stevens, will take on the role of chief executive of NHS England in April next year, UNISON Head of Health Christina McAnea said:

“The NHS is facing its first serious crisis for the best part of the decade, and it is critical that Simon Stevens respects and shares the values of our NHS – universal healthcare that is free at the point of need.

“It is surprising that no one within the NHS has been found to take on this position. We sincerely hope this is not a sign that the government wants to import America-type values into the NHS and look at ways of developing healthcare through an insurance model. If this is the intention there will be massive opposition.

“Mr Stevens will have his work cut out for him right from the start. Far from being protected from government cuts, the NHS is being starved of the funds it needs. Thousands of jobs are under threat and accident and emergency departments are creaking under the pressure of cuts, privatisation and upheaval.”

(UNISON is a UK trade union of public employees)


Simon Stevens, new head of NHS England, is in for a rude awakening

Under Labour, Stevens began the culture of competition in health. He will now find out just how perverse this has become

By Polly Toynbee
The Guardian, October 24, 2013

As he sowed, so shall he reap. Simon Stevens will get his just deserts as he takes up the reins of NHS England, only to find this horse has no bridle or bit, galloping out of anyone’s control. That was, of course, precisely the explosive “creative destruction” Andrew Lansley intended. Stevens returns from the biggest US health company to an NHS whose current path he designed as Tony Blair’s adviser. Now he must piece together some coherence from the fragments of what Sarah Wollaston, MP and GP, called “a grenade” tossed into the NHS.

As Lansley outlined his scheme in 2010, Stevens wrote a paean of praise in the Financial Times. It reads as a touchingly optimistic vision, where choice and competition in a perfect market deliver everything a patient or GP could desire. When he sees what he’s inherited, he may get a rude awakening. But he shares the blame, claiming authorship: “What makes the coalition’s proposals so radical is not that they tear up (our) earlier plan,” but “move decisively towards fulfilling it – in a way that Mr Blair was blocked from doing by internal opposition”.

He lists the plan’s glories: in “the new model NHS, patients are rightly being promised that ‘no decision will be made about me, without me'”. No sign yet of that. He praises “the severing of day-to-day political control of the NHS”, but now he’ll find his own control severed. How will he marry his vouchers for pregnant women with wildly unpopular maternity closures? His hope that “patient power will become real, GP commissioners will fire on all cylinders and hospitals will be liberated to innovate” is a world away from today’s NHS.

But his greatest regret may be his praise for “the decision to extend competition law across the health sector and treat the NHS as a regulated utility, with an economic regulator – Monitor”. Faith in competition fills his writings – but reality is biting back. Monitor, engine of NHS competition, has only just understood its destructive force: its chief executive, David Bennett, recently recoiled, saying Monitor would be “mad” to enforce the Lansley competition rules leaving commissioners to “spend all their time running competitive processes because they’re terrified they’re going to get in trouble if they don’t”. Too late now.

So far, 63% of contracts have been put out to tender by clinical commissioning groups (CCGs), now run by just a few GPs. The 211 CCGs are widely regarded as no match for the private sector in writing complex contracts. Section 75 of the Health and Social Care Act forces them to put all but a few services out or risk any putative bidder challenging them in court. Bringing competition law into the NHS means no one can control these unleashed forces.

Watch Stevens demand more changes to the law if he’s to control the unfolding chaos. Half of NHS trusts have announced a deficit for this year – that’s unprecedented – yet by 2017 the NHS must “save” £30bn. The Care Quality Commission says one in four hospitals are a safety risk, but their inspections aren’t allowed to count numbers of staff: the NHS has haemorrhaged 6,000 nurses since 2010. Many CCGs that control NHS funds are chaotic, with services falling between gaps, no one paying for them. Privatisation rushes on, at least £11bn so far, but private providers escape the NHS duty of openness or freedom for whistleblowers. Waiting times are rising, ambulance and A&E times growing, as the social care crisis blocks NHS beds with winter approaching.

Stevens will find many perversities in the competition culturre. He said top-down control was a disaster – but he may find fragmentation and lack of strategic control far worse. Can he make his perfect market work – or admit he might have been wrong?


The National Health Service in England currently exemplifies the greatest problem with publicly-administered and publicly-financed national health programs: They become subject to privatization efforts whenever conservatives gain control of the government. Selecting UnitedHealth’s Simon Stevens as chief executive of NHS England surely advances Conservative Prime Minister David Cameron’s privatization scheme.

When do you suppose UnitedHealth will put in a bid to purchase the NHS? It would be great for Cameron’s budget, though the people would lose out.