Simon Stevens’ appointment gives NHS England something to smile about at last, argues Mike Birtwistle.

Plenty of people have already written about why Simon Stevens is a good appointment as chief executive of NHS England. He is fiercely intelligent but pleasant with it. He has plenty of experience of both the NHS and health abroad. He is conversant in both political and management speak. Perhaps most importantly Simon Stevens actually has a track record of leading a large health commissioning organisation (something that not many people with a background in the NHS can point to).

However, what the appointment says about NHS England is as important.

‘It is hard to be an effective system leader if no leaders want to work for you.’

Incisive Health’s office is just around the corner from NHS England’s London building. This morning I walked past and someone went in smiling. It is no exaggeration to say I haven’t seen this happen before. Okay, so n=1 – and I’m sure some people have walked into the building smiling before – but it is undeniable that this appointment will put a spring in the step of people who did not have had much to smile about over the last year.

It is hard to be an effective system leader if no leaders want to work for you. Yet since before it was even legally established, NHS England has been haemorrhaging top talent, resembling little more than fertile recruiting ground for the Care Quality Commission and the private sector.

Game-changer

The appointment of Simon Stevens changes this. 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 Özil. After years of losing his best players, Arsene Wenger signed one of the world’s best. It gave the fans and players a huge lift and it made the rest of football take notice. Malcolm Grant will hope that his signing will do the same for NHS England, changing the organisation from being the poor relation to the Department of Health, CQC and just about any other part of the new system to once again being something to be reckoned with.

In recent months NHS England has looked like an organisation waiting to be abolished. The health secertary has become increasingly activist in his dealings with the supposedly independent body, the solution to all problems has shifted from being commissioning to regulation and Labour remain as opposed as ever to having an “independent” board.

‘Malcolm Grant will hope that his signing will do the same for NHS England, changing the organisation from being the poor relation to once again being something to be reckoned with.’

On all counts, Stevens’ appointment offers some hope. It is highly doubtful that he would be signing on with an organisation he thought was about to be abolished. There can of course be no complete assurance of this, but this move is a powerful vote of confidence.

The new role will also reunite Stevens with his Oxford contemporary Jeremy Hunt (rumour has it the health secretary remembers Stevens, but not the other way round). His background on the political side of the operation will be invaluable in negotiating the tricky dynamics between a secretary of state who appears less than a true believer in independence and a board which has yet to work out how to exercise it effectively.

The C-word

Once he has got over the awkward conversations about university days, Tony Blair’s former adviser will need to bring to life how commissioning can deliver the changes demanded of the NHS by its political masters. The C-word is notable by its absence from the Hunt lexicon. By appointing someone who actually knows about commissioning, NHS England will be hoping to redress this balance.

‘A single appointment can change the dynamic and this one has, as much for what Simon Stevens stands for as for who he is.’

Finally, Stevens’ appointment is a political coup, proving that those on the centre ground can work with the post-April 2013 system and have enough confidence in it to put their careers on the line to do so. It also offers an opportunity to build some cross-party consensus that there is a future for NHS England. This is not simply about Simon Stevens’ Labour background (although this is important). His understanding of the politics of health (on both sides of the Atlantic), as well as what will drive politicians will be invaluable.

A single appointment can change the dynamic and this one has, as much for what Simon Stevens stands for as for who he is. It has put NHS England back in the big leagues. Whether it can stay there remains to be seen.

This article was also published in the Health Service Journal.