Chief Executive of NHS England
As the NHS England CEO,Stevens has been directly accountable to Parliament for management of £150 billion of annual NHS funding. He frequently gives evidence to the Public Accounts Committee,the House of Commons Health and Social Care Committee,and other Parliamentary committees. He has used the statutory independence of NHS England to speak openly about NHS funding and reform. [36] As of 2020,Stevens was paid a salary of between £195,000 and £199,000 by NHS England [37] and each year he has opted for a voluntary £20,000 pay cut. [38]
According to Fraser Nelson,hiring Stevens back to run NHS England was one of the cleverest moves that David Cameron made because he "knows more about NHS problems and market solutions than any man alive". [39] The Guardian reported one health expert as saying "He's coming back to a pay cut [and] the mother of all messes". [40] Stevens' own assessment was that "For the NHS the stakes have never been higher. The global recession has meant the NHS facing its most sustained budget crunch in its history. Service pressures are intensifying,and longstanding problems are not going to disappear overnight." [41] Stevens said his aim was to "Think like a patient,act like a taxpayer." [42] In a speech following his appointment to the role of CEO in 2014 he set out an agenda for reform. [43] A profile in the British Medical Journal claimed he is "intellectually gifted,charming,funny,and a great communicator. He is a natural and persuasive leader who exudes quiet confidence. He is widely read and writes superbly. He's got such a big brain he can be easily bored [but] he is a 'natural egalitarian'. Another comments,'The new system is about distributed leadership. That will play to his strengths. He’s very collegiate.' A third says,'He’s pragmatic and not ideologically driven. He’ll ask how we can make this work. He’s seen the rough end of the NHS - Stevens’s predecessor in one post [died by] suicide'." [44]
During the 2019 general election campaign,while the Labour Party said they would generally not comment on public officials,they stated they had a "good relationship with Simon Stevens and respect him." [45] [46] In March 2019 it was announced Stevens would also lead the hospital regulator,NHS Improvement,effectively merging it into NHS England. [47]
As NHS England Chief Executive,he has given lectures and speeches at the universities of Oxford,Cambridge,Durham,Exeter,London,Birmingham,York,Manchester,Southampton,Newcastle,and previously at Harvard,Yale,and NYU. Before taking up his NHS role,from time-to-time he authored articles in various health-related research journals. He is regularly interviewed on the BBC,ITV,Sky News, Channel 4 News and The Today Programme ,as well as The Andrew Marr Show . [48] He has also appeared on Jeremy Vine , [49] BBC Breakfast , [50] Any Questions? [51] and The One Show .
Innovation and research
As CEO of NHS England Stevens oversees £19 billion of annual investment linked to medical and life sciences specialised services,innovation and R&D. [52] He also established a ring-fenced fund within NHS England worth £680 million annually for innovative new medicines,particularly for rare conditions. [53] He has actively promoted genomics,and cell and gene therapies on the NHS. [54] [55] [56] [57] In autumn 2018 he announced that the NHS had become the first health service in Europe to negotiate approvals for newly licensed breakthrough CAR-T cancer therapies. [58] [59] NHS England successfully negotiated the introduction of whole exome sequencing to diagnose rare diseases in children. [60] In March 2021 Stevens announced that NHS England had also successfully negotiated a confidential deal to make available a gene therapy said to be "the most expensive drug in the world" with a reported list price of £1.8 million per patient. [61] [62] [63] He also launched an international research partnership on early cancer diagnosis using advanced blood tests. [64] [65]
He publicly refused to accept the prices US drug company Vertex initially wanted to charge the NHS for its cystic fibrosis drugs,until the company eventually agreed a confidential discounted deal for UK patients. [66] [67] [68] He also accused Essential Pharma of "using the cover of coronavirus to try and price-gouge British taxpayers". The UK Competition and Markets Authority subsequently took action,calling the company's plans "particularly concerning". [69]
He has pushed the use of AI and Machine Learning in healthcare [70] [71] and NHS England is hosting a new £250 million NHS AI Lab. [72] [73] [74] Speaking at the World Economic Forum in Davos he launched the first wave of NHS Innovation Test Beds. [75] [76] and introduced a new NHS innovation payment. [77] NHS England funds Academic Health Science Networks,and Stevens supported the Accelerated Access Review arguing:
"As a nation we need to pursue three goals simultaneously. First,we must actively support new discovery and further development of innovative treatments and care. Second,we have no choice other than to drive value and affordability across the NHS if we're going to create headroom for faster and wider uptake of important new patient treatments. And third,in the run-up to Brexit we need not only to secure - but enhance - our vibrant and globally successful UK life sciences sector." [78]
Stevens took action to stop NHS funding of homeopathy,on the grounds that it is "at best a placebo and a misuse of scarce NHS funds." NHS England was sued by the British Homeopathic Association who argued that Stevens' criticisms,including on the BBC Radio 4 Today programme,prejudged its public consultation. The High Court dismissed the BHA challenge,and backed NHS England. [79] [80] [81] In 2019 Stevens added:"Anything that gives homeopathy a veneer of credibility risks chancers being able to con more people into parting with their hard-earned cash in return for bogus treatments which at best do nothing,and at worst can be potentially dangerous". [82] [83] He later warned patients not to believe claims that homeopathic 'duck extract' was an effective covid treatment. [84] In a speech at Oxford University he took aim at the "dubious and dodgy" anti-science in Gwyneth Paltrow's Netflix show, The Goop Lab . [85] [86]
He was responsible for the Five Year Forward View [87] produced by NHS England in October 2014. [88] This marked the beginning of a major shift in how NHS care is delivered,in contrast to NHS policy since 1991. Instead care is increasingly being redesigned to achieve what Stevens labelled the "triple integration" of primary and specialist care,physical and mental health services,and NHS and social care. [89] [90] He has argued that government pay freezes for NHS staff,made to achieve cost savings,threatened the NHS's ability to recruit and argued that NHS wages should keep pace with the private sector. [91]
He has told the BBC that the COVID-19 pandemic has accelerated the move to integrated care:
"People have said this was the biggest health challenge since World War Two. It was in preparation for the Blitz in 1939 that hospitals started working together in Emergency Medical Service which became the embryonic NHS. You could argue that over the last twelve months the way the NHS has mobilised for the vaccination programme,and also the way hospitals worked together to ensure patients got the intensive care they needed,together with better working with community services and local government - that sets the blueprint for the next phase of our NHS." [92]
From April 2021 the whole of England is now covered by Integrated Care Systems responsible for improving population health,cutting inequalities,and joining up local services. [93]
Stevens has prioritised the modernisation of primary care, [94] mental health and cancer care [95] having commissioned an independent national taskforce led by Sir Harpal Kumar the chief executive of Cancer Research UK. [96] Breast cancer deaths have subsequently fallen faster than in other large European countries and outcomes are estimated to have caught up with or surpassed the European average. [97] In 2015 he commissioned the independent Five Year Forward View for mental health,chaired by Paul Farmer the head of MIND. [98] He subsequently introduced shorter waiting times standards for mental health services, [99] [100] directed that each year local mental health spending must rise faster than overall NHS funding growth, [101] and then extended that commitment to primary care and community health funding. [102] He has however recently challenged the longstanding assumption that this will mean there is a need for fewer hospital beds. [103]
Given increasing concerns about young people's mental health and eating disorders, [104] he voiced concern on the BBC's Andrew Marr Show about cosmetic surgery adverts during ITV's Love Island series. [105] Shortly after,ITV's chief executive agreed to reconsider the ads, [106] and the Advertising Standards Authority went on to ban them. [107] He has suggested that social media companies might be asked to contribute to funding improved mental health support for young people. [108] [109] He has announced a dedicated confidential national mental health support service for NHS doctors, [110] and 40 new mental health hubs for NHS staff affected by the COVID-19 pandemic. [111]
Stevens is a supporter of expanded university places for the health professions such as undergraduate medicine and nursing, [112] which could also meet the "surge in interest" in these careers in the wake of the coronavirus pandemic. [113] [114] As well as supporting expanded health training opportunities for UK workers,he has backed ongoing selective international recruitment in the NHS. [115] In October 2015 speaking to the Institute of Directors at the Albert Hall he queried why ballet dancers but not nurses were on the Home Office's 'shortage occupation list. [116] A week later the government added nurses to the list. [117]
He led the introduction of an NHS Workforce Race Equality Standard to track and improve the experience and fair treatment of Black,Asian and Minority Ethnic Staff across the health service, [118] [119] and agreed to create and fund the NHS Race and Health Observatory. [120] [121] He proposed the creation of a 'freedom-to-speak-up index',which is now used across the NHS to track the openness with which staff concerns can be reported. [122] He supports tougher regulation of health care managers, [123] and has openly criticised care at a small number of maternity units,backing needed improvements with a £97 million investment package. [124] Stevens supports a greater role for the voluntary sector and volunteering in the NHS,as a complement to the work of NHS staff. [125] [126]
Stevens has pushed to give local communities more control over national budgets,including stronger 'Devo Manc' regional powers for Greater Manchester. [127] He has repeatedly argued for the importance of social care. [128] [129] [130] In October 2018 he pledged up to £50 million for extra NHS support for the community affected by the Grenfell Tower fire. [131] The Local Government Chronicle ranked him the most powerful figure in local government. [132]
NHS funding and Brexit
Stevens has argued that "One of the problems with NHS funding over the last 70 years has been its volatility. So,we bounce off the banks between boom and bust and that makes it very hard to plan services." [133] In November 2017 Stevens gave a high profile speech making the case for a return to NHS funding increases in line with historic norms and independently assessed requirements. [134] [135] He did so against the backdrop of a Vote Leave poster which had promised £350 million a week for the health service and which,he said,the "public want to see honoured". His call was widely supported both inside the NHS [136] [137] and outside it,ranging from Brexit-supporting Jacob Rees-Mogg [138] [139] to the Remain-supporting general secretary of the TUC. [140]
In June 2018 –just ahead of the NHS' 70th Anniversary –the Prime Minister Theresa May announced extra funding for the NHS worth an average real terms increase of 3.4% a year,reaching £20.5 billion extra in 2023/24. [141] Stevens led the NHS' 70th anniversary celebrations, [142] including giving the address on 5 July 2018 in the national service of thanksgiving at Westminster Abbey. [143] [144] [145] [146]
The Archbishop of Canterbury and Stevens wrote jointly on the 72nd anniversary of the NHS in July 2020 that:"Our NHS is the embodiment of the spirit of community. It has become a unifying ideal across this nation,and down the generations. A health service that belongs to us all —to those of all faiths,and of none;there when we need it,at some of the most profound moments in our lives;the practical expression of a shared commitment by the British people,rooted in the idea that every person is of equal worth." [147]
NHS Long Term Plan
On 7 January 2019 Prime Minister Theresa May and Stevens jointly launched [148] the NHS Long Term Plan,co-authored in conjunction with patient groups and NHS clinicians. It set out how the NHS will use its extra funding to redesign care and improve outcomes over the decade ahead. [149] Prime Minister May spoke at the launch giving government backing to the plan. [150]
In drawing up the NHS Long Term Plan,NHS England was also asked by the cross-party House of Commons Health and Social Care Committee,and by the Prime Minister,to make recommendations on possible changes to health legislation. Stevens came forward with proposals to substantially amend the government’s previous 2012 legislation. [151] [152] [153] A wide range of stakeholders called for an NHS Long Term Plan including the Age UK,Macmillan Cancer,the British Red Cross,RCN,Unison,the Medical Royal Colleges,the Kings Fund,NHS Providers,the NHS Confederation,the Local Government Association,Alzheimers Society,British Heart Foundation,Diabetes UK,the Stroke Association and the Patients Association. This letter specifically called for the removal of Section 75 of the 2012 Health and Social Care Act. [154] The new government of Boris Johnson announced in the Queens Speech of 14 October 2019 that it would back the Long Term Plan,legislate for the £20.5 billion real terms funding increase,and introduce legislation to give effect to the NHS's recommended legal changes. [155] [156] Stevens proposed - and NHS England then established - an 'NHS Assembly' to help steer implementation of the NHS Long Term Plan. [157] It comprises a diverse range of stakeholders including national and local patients' groups,NHS staff and clinical experts. [158]
NHS response to COVID-19
Prime Minister Boris Johnson was reported to have put Stevens personally [159] and the NHS generally ( as against the private sector or the Department of Health and Social Care) in charge of designing and managing the national COVID-19 vaccination rollout. [160] [161] NHS planning began in summer 2020 [162] for what Stevens described as "the biggest vaccination campaign in our history... and a decisive turning point". [163] [164] The NHS was the first health system in the world to administer the Pfizer–BioNTech vaccine,on 8 December 2020, [165] [166] [167] [168] and then the Oxford–AstraZeneca vaccine on 4 January 2021,which he described as "a major milestone in humanity's battle against coronavirus". [169] By mid-January 2021 Stevens reported that people in England were being vaccinated four times faster than new COVID cases were occurring. [170] By mid-February the NHS was delivering "Europe's fastest and largest COVID vaccination programme" [171] and he said that vaccine uptake was far higher than had been envisaged,with over nine out ten people accepting the invitation. [172] He stated that improved vaccine supply for the second phase of the NHS vaccination campaign from mid-February to April 2021 would allow the NHS to further double the speed of vaccinations. [173] The target of offering vaccination to all adults by the end of July 2021 was delivered a month early. [174] [175]
Stevens also told MPs in January 2021 that COVID-19 could become a "much more treatable disease" over the next six to 18 months,raising the hope of returning to a "much more normal future". [176] [177] He praised NHS staff and researchers for developing new COVID therapies,which may have saved an estimated one million lives worldwide. [178] He also allocated funding to establish the first NHS long COVID clinics. [179] [180]
During both the spring 2020 and winter 2020–21 waves of COVID he expressed concern about the slogan "Protect the NHS",arguing that the NHS was there to protect patients,and the slogan could put people off coming forward for care. [181] [182] [183] [184] He said that "Rather than say 'Protect the NHS',health service staff prefer to say:'Help us help you.' Keeping coronavirus under control means we avoid displacing other treatments which our nurses,doctor and therapists desperately want to sustain." [185]
On 4 November 2020 Stevens put the NHS back on its highest level of emergency preparedness, [186] [187] which was maintained until 25 March 2021. [188] During this period he appeared at a number of televised 10 Downing Street COVID press conferences alongside the Prime Minister - on 5 November, [189] 2 December,7 January (at which he accused 'COVID deniers' of lying), [190] 26 January,and 15 February 2021 (where he reported the NHS had successfully met its target of offering all high risk patients their first vaccination). [191]
By late December 2020 he stated the NHS was back in the "eye of the storm". [192] [193] [194] In mid-January 2021 he told The Andrew Marr Show:"The facts are very clear and I'm not going to sugar-coat them: hospitals are under extreme pressure and staff are under extreme pressure. Since Christmas Day we've seen another 15,000 increase in inpatients in hospitals across England. Every 30 seconds across England another patient is being admitted to hospital with coronavirus." [195] At the Downing Street press conference on 26 January 2021,according to political commentator Paul Waugh, "When NHS chief Simon Stevens was asked whether there was too much household mixing in December... he was admirably frank:'The facts as we see it in the health service are that on Christmas Day we had 18,000 coronavirus positive patients,and now we've got just under 33,000.'" [196]
In January 2021 he marked the anniversary of the first COVID patients being treated by the NHS in Newcastle, [197] [198] and in March 2021 the NHS joined the national day of reflection. [199] He has described the health service's response to the pandemic as "The NHS at its most agile and committed best." [200] Responding to the proposal that NHS staff should only get a 1% pay rise after the pandemic,Stevens appeared to disagree,stating that the NHS had instead been budgeting for a higher figure,and he argued that the independent pay review bodies should be able to make their recommendations "without fear or favour". [201] [202] [203]
He gave the address at the national service of commemoration and thanksgiving at St Paul's Cathedral on 5 July 2021, [204] [205] [206] coinciding with the award of the George Cross to the National Health Service by Her Majesty the Queen. [207]
Prevention and public health
Stevens has drawn attention to online sources of misinformation about vaccine safety. [208] He has noted that "although nine in ten parents say they support vaccination half of them say that they have seen fake messages around vaccination on social media," and "if parents are being told that their children shouldn’t be vaccinated,it’s as irresponsible as saying 'don’t tell your children to look both ways before they cross the road on the way to school". [209] [210] He called on social media sites to take action against misleading and untrue health claims. [211] [212] Both Instagram [213] and Facebook [214] subsequently agreed to do so. [215] He has also spoken out against a "pandemic of disinformation" affecting uptake of covid vaccination in some communities and some countries. [216]
Stevens argues that "obesity is the new smoking" [217] [218] and has pushed for greater NHS,family,business and government action to tackle it. [219] [220] He initiated NHS England's work with local authorities and developers to 'design in' health promoting built environments,and launched the obesity-reducing NHS Diabetes Prevention Programme [221] and later backed its national expansion. [222] He has championed NHS work to cut sugary drinks and junk food from hospitals, [223] and suggested there should be a national sugar tax. [224] In March 2016 Chancellor George Osborne announced a tax on sugary drinks. [225]
On climate change and on environmental health threats he told the Royal Society of Medicine that "We have over 2,000 GP surgeries and hospitals located in zones with poisonous air [and] Public Health England estimates [air pollution will lead to] about 2.4 million cases of avoidable illness between now and 2035." [226] For these reasons Stevens argues that:"The climate emergency is a health emergency,and we,the NHS,as the single biggest organisation across this country are both part of the solution and part of the problem. We are 40% of public sector emissions,and although we have reduced our carbon footprint by around a fifth over the past decade,we've got to make major changes if we're going to help this country become carbon net neutral." [227] [228]
In 2020 Stevens appointed an expert panel to develop a route map to decarbonise the health sector, [229] and the NHS subsequently pledged to become the world's first healthcare system to cut carbon emissions to net zero. [230] [231] Dr Tedros Adhanom Ghebreyesus,director general of the World Health Organization,welcomed the NHS's global leadership in doing so. [232]
In response to rising knife crime,Stevens appointed trauma surgeon Martin Griffith to lead the NHS' work on violence reduction, [233] educating children about the consequences of stabbings,alongside youth workers helping victims of gang crime while they are still being treated in hospital to help break the cycle of violence. [234] He has pointed to the growing problem of gambling addictions,and the predominance of sports-related gambling promotions. [235] [236] The NHS has opened new specialist clinics which Stevens argued the industry should contribute to funding. [237] [238] Shortly after Stevens' criticism,the six largest gambling companies announced a tenfold increase in their industry contributions to services for people affected by gambling. [239]
Stevens has argued that the NHS –as the largest employer in Britain –is an 'anchor institution' in many local communities,and so needs to "get more creative in developing staffing and clinical models that will enable us to sustain services and consider second and third order effects in terms of jobs and economic impact and social cohesion". [240]
