Simon Stevens' exit strategy

Until now HSJ has answered “not any time soon” – but that is not our response anymore.

HSJ understands that Mr Stevens has set out his exit strategy to NHS England chair David Prior and his NHS Improvement counterpart Dido Harding.

As a result, it is possible to make this statement: This week sees the annual NHS Confederation conference. Simon Stevens is likely (but not certain) to be NHS England chief executive during the 2020 event; and likely (but not certain) not to be in the role when the 2021 conference rolls round.

The very good reasons why Mr Stevens will not want to leave for at least the next 12 months are the following.

Before the end of July, we will see a new prime minister, and very probably a new chancellor and a new health secretary.

What’s likely to follow is a “no deal” Brexit and/or a general election which could see the arrival of a Jeremy Corbyn Labour-led government. This latter scenario would mean a change of chairs for both NHS England and Improvement, both of whom are Conservatives (and potentially Mr Stevens’ fourth set of PMs, chancellors and health secretaries).

During the same period there will be a spending review to negotiate (with big decisions to be made on capital, public health, and education/training), the possibility of reforming legislation to negotiate with the new prime minister/health secretary/government, and the access targets review to conclude.

Mr Stevens, the most politically skilled public service leader of his generation, is not about to leave that job to anyone else. He knows how pivotal the decisions taken in 2019 and 2020 on issues right across the public services sphere and beyond will be to the country’s long-term future. As his recent Royal Society of Medicine lecture shows, he is determined the NHS and England’s wider health interests will be at the heart of the debate on issues as diverse as economic revival, social cohesion and the climate emergency. He is also convinced that he is best placed to make those arguments.

At the same time, Mr Stevens understands the next 12 months must see the drive towards a country-wide network of integrated care systems pick up and maintain an irreversible momentum. The indefatigable Mr Stevens has been touring the country relentlessly running the rule over system plans to ensure this.

Then, of course, there is also the little matter of the service’s financial woes  – now firmly in Mr Stevens’ lap as Ian Dalton gets ready to leave NHS Improvement; the ongoing “merger” between NHSE and I; and the need to make sure priorities mental health getting a bigger share of the pie and improving cancer diagnosis do not slide off the agenda. 

Faced with such a to do list, only the most committed leader would have not already handed in their notice.

However, the reasons why Mr Stevens is likely to depart sometime from next summer onwards are just as compelling.

First and foremost, he will have done his time. His three predecessors in the role (or its equivalent) all served between six and eight years.

Should Mr Stevens leave in 2020-21, he will have secured enough money to keep the NHS afloat until 2024 (if the public spending review goes well for the NHS). He will have overseen reforms which have effectively ended the 30-year era of the internal market as the prime driver of change, and in its place put a focus on integration and collaboration. He will also have had enough time to pass on knowledge to his new senior team, which includes a finance director and chief people officer freshly arrived in health, as well as the recently appointed chief operating officer.

Both Mr Stevens’ staying and leaving scenarios need the proviso, “but not certain”, due to the sheer unpredictability of many of the factors mentioned above.

To say that Mr Stevens’ departure in 2020-21 would be a blow is to make the grandest understatement. The field of credible replacements is as vanishingly small as when Mr Stevens was appointed, and although he will have achieved much by 2020, there will inevitably be more to do to entrench the reforms he has started.

The prime minister who can persuade Mr Stevens to stick around to, say, 2022, will be doing the country a great service as the majority of challenges likely to emerge during the next three years are closely-matched to Mr Stevens’ unique skill-mix of intellect, political savvy and NHS knowledge.

Nevertheless, should Mr Stevens stick to his plan A of departing during 2020-21, few would blame him. His six(ish) years will have been the most tumultuous of any NHS chief. As a result, they have consumed almost his every waking hour and, no doubt, quite a few of his sleeping ones too.

As for the succession race, it will be a marathon and not a sprint. The judges and the rules are likely to change (possibly more than once). But make no mistake – minds have already begun to turn to the toughest gig in British public service leadership – following Simon Stevens.