NHS: PM Prepares to Blame Health Chief

The buck usually stops with the person at the top of an organisation, large or small, and the Westminster system of ministerial responsibility also makes it clear that ministers and Cabinet secretaries have to accept responsibility for the performance of their departments.

But not according to Theresa May.

The Prime Minister has decided that if the many warnings that health experts have given Health Secretary Jeremy Hunt about a potential NHS crisis this winter do come true then the buck will not stop with the Health Secretary but with the civil servant who heads NHS England, Simon Stevens (above).

This remarkable upending of political convention is not the first time that May has been more slippery and unpredictable than “strong and stable.”

“It’s His Fault”

When the Chancellor decided earlier this year to raise National Insurance payments for some workers the PM had belated second thoughts and ordered a turnaround amid speculation about an early election. “There isn’t going to be one, it isn’t going to happen,” she promised in March. Whoops. A month later, when the Tory opinion poll lead was in double figures she decided it would happen after all.

There have been other changes of direction over social care, foreign worker lists, a British bill of rights, and other policy items but this is the first time that May has upended the concept of an elected politician being responsible for what happens on his watch.

May has told Stevens, a 51-year-old career health manager and policy adviser, that he is personally responsible for ensuring the health service does not end up in a crisis this winter.

At a previously unreported meeting in Downing Street in September she told the NHS England chief executive that he would be held accountable for how well hospitals and GP services in the country cope through the winter.

“The Prime Minister made it very clear that Simon Stevens was personally responsible for and accountable for the NHS’s performance this winter,” a source told the Guardian newspaper. “There was a long pause, as the enormity of this sunk in. He had to accept it because she was making it clear that he was in charge of winter.”

For months the major health-related organisations covering everything from nursing and ambulances to GPs and psychologists have been warning publicly: “We need more money or there will be a serious deterioration in services over winter.”

The Government has steadfastly refused to provide that funding and May now appears to be shifting blame in advance. Her relations with Stevens, a former Labour Party councillor in Brixton who was a policy adviser to Tony Blair and was appointed to his current job by David Cameron, have become increasingly strained.

Last week the NHS chief executive attacked Government under-funding at an NHS conference, cheekily declaring that the NHS should receive the extra £350m a week that was promised during the EU referendum by members of May’s Cabinet such as Boris Johnson, Liam Fox and Michael Gove.

Winter Fears

Colleagues of Stevens believe that it is unfair and unrealistic to expect him to be responsible for the NHS’s entire performance, especially given its tight budget and under-staffing.

Hospitals came under huge strain last winter, with dozens forced to go on “black alert”, a declaration that they could not cope with the number of patients needing care.

That crisis has prompted unprecedented efforts by agencies such as NHS England, NHS Improvement and Public Health England to ensure the chaos is not repeated this winter.

Allies of Stevens believe this teamwork shows that maintaining safety and quality of care in winter requires collaboration, and no single NHS agency can do everything required so it is wrong to expect Stevens rather than Hunt to take the blame if things go badly.

Nigel Edwards, chief executive of the Nuffield Trust health think tank, said any attempt to make one person responsible for performance over the winter showed an ignorance of how the NHS worked. “The idea that a single figure can be personally in charge of the performance of a system as large and complex as the NHS is one of the most persistent and damaging myths in healthcare,” he said.

by Bob Graham

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