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The NHS five year forward view: the man matters more than the plan

Something very important happened on Thursday and it wasn’t the publication of the NHS five year forward view.

Far more important was the passion and confidence with which Simon Stevens launched the plan and challenged politicians to provide the funding needed to deliver it. His performance stood in stark contrast to the bickering over the despatch box on the same day, when Labour and the Conservatives sought to claim the plan as their own.

Commentators on the right and the left found much to admire in Stevens’ advocacy of the case for change and his skill in rising above narrow partisan debates on the NHS. So much so that the story centred on Stevens’ own role as the de facto leader of the NHS, and the critical part he has to play in navigating the treacherous waters that lie ahead.

The elevation of Stevens should be a cause of celebration not regret among politicians. The role of Health Secretary has always been challenging, never more so than in the current climate when funding and service pressures are growing by the day.

To be sure, there are risks for Stevens in assuming the mantle of NHS leader, not least the willingness of leaders of other national bodies to support him in this role. While he can rightly take credit when progress is made, he will have to shoulder blame when the performance of the NHS goes into reverse. He also risks being the fall guy when there are major failures of patient care, such as those that occurred at Mid Staffordshire, which in reality he has little power to prevent.

On the other hand, he has an unprecedented opportunity to lead the NHS with greater detachment from politicians than has been possible for his predecessors, provided he is allowed to do so. Stevens has the twin advantages of having worked for much of his career in the NHS as well as serving as an adviser to Frank Dobson, Alan Milburn and Tony Blair. Add to this the air of authority that observers noted in his handling of the launch of last week’s plan, and it is easy to see why his stock has risen so rapidly.

Ahead of last Thursday, background briefings suggested that the NHS five year forward view was ‘not Simon’s and was not a plan’. On both counts they were fundamentally wrong. Although presented as the collective view of national leaders of the NHS, there is no doubt that it bears his imprimatur, and that it sets the direction for the NHS for the next five years and beyond.

There may be little that is original in the plan but it outlines persuasively the case for change and the new models of care needed in the future. It also avoids offering a national blueprint, instead giving leaders of NHS organisations freedom and flexibility to adapt these models to the circumstances in which they find themselves. In doing so, it echoes the Fund’s argument that reforming the NHS needs to rely much more on improvement occurring from within organisations rather than being driven from the centre.

The appointment of a leader who knows the NHS from the inside and who is rapidly gaining the confidence of those providing care creates a once in a lifetime opportunity to change fundamentally how the NHS is run. Taking the NHS out of politics entirely may never be possible but placing politicians in the role of allocating resources and setting the direction for the NHS while leaving it to others to turn plans into practice suddenly seems an achievable goal. The prize for health ministers is to enhance their own position by doing less while properly remaining accountable for the overall performance of the NHS.