Stevens is dismantling the recent past to make way for the NHS's future

History will not judge Andrew Lansley’s record as health secretary kindly, the King’s Fund has concluded. There seems little doubt of that, but it is for what he did not do, rather than what he did, that history is likely to reserve its sternest judgement.

The reforms created an environment in which the NHS was bound to lose the opportunity to begin climbing the efficiency mountain or to stage a serious rethink of the way in which care services should be planned and provided.

Yet despite this unpromising context, NHS England chief executive Simon Stevens still believes the NHS is in “one of the best positions it’s ever been in” to meet the challenges ahead. In an in-depth interview he declared: “Collectively we have a game plan, a shared sense of direction, and it’s time for us to seize the moment.”

Making it stick

Good as his word, Mr Stevens then set about dismantling the recent past to make way for the future.  

The NHS England chief would deny the crude interpretation that his plans for a “voluntary tariff” kick the legs away from the financial system created by the Health and Social Care Act (and previous reforms), and, in any case, there is no guarantee his idea will stick.

‘It’s unlikely the NHS will ever fully return to Lansley’s price setting system’

However, his comments suggest a world in which the existing tariff system would be overhauled by any incoming government and an NHS leadership focussed on meeting immediate challenges can be relatively relaxed about side stepping the regulatory strictures created by the act.

Poor Mr Lansley, his act is not yet dead, and already it is being effectively ignored. It is unlikely the NHS will ever fully return to the price setting system he conceived.

Strike two

Clinical commissioning groups, the centrepiece of the Lansley reforms, no longer appear to be the default drivers of change. The voluntary tariff will not be optional for them and it was notable Mr Stevens was comfortable exploring a future in which GP leaders concentrated their efforts on developing new provider organisations and in which CCGs devolved their powers to others.

Strike two against the reforms, although Mr Stevens is likely to be just as robust in resisting any overzealous attempts to strengthen the influence of health and wellbeing boards where he believes that is not justified.   

The NHS England chief was also very strong in signalling a return to collective responsibility for the financial performance of healthcare economies – moving away from the idea the service consists of independent actors kept honest via regulatory oversight. “My institution right or wrong is not going to be what’s required” from the service’s new generation of leaders, he states. This belief is combined with a desire to create the ability to stage “collective action”.

‘If we’ve learned anything from Lansley’s tenure it is that the NHS wastes time at its peril’

He is clearly very frustrated by what he sees as avoidable inefficiencies within the provider sector; inefficiencies which, for example, have resulted in funds hard won from the Treasury to alleviate the pressure on elective waiting lists left unspent.

Mr Stevens believes he is in the process of re-establishing the credibility of the NHS as a sector that can both reform and deliver, declaring “the NHS is without doubt the leanest of any health services in western Europe”, but adding “it’s vitally important the health service can demonstrate we’re pulling all the stops out on the efficiency front”.

While he recognises not all overspending is within the control of providers, organisations which undermine the credibility of that case can expect an atypically fierce reaction. The quid pro quo for a more attractive tariff could well be greater transparency over provider productivity and sharp edged determination to reduce unwarranted variation.

One final point – Mr Stevens joins the chorus of those senior figures arguing for wisdom of merging Monitor and the NHS Trust Development Authority. An election makes the timing of this inevitable announcement controversial – but Messrs Hunt, Burnham and Lamb would show understanding of the service’s best interests if they signalled their in principle agreement.

This would allow the informal preparations to move from the cafes and corridors in which they are currently taking place. If we learned anything from Mr Lansley’s tenure it is that the NHS wastes time at its peril.