In England, the NHS is run by an organisation with an identity crisis. It calls itself NHS England, but that’s just self-promotional branding. In law, it is the NHS Commissioning Board, created by Andrew Lansley’s controversial 2012 reforms which gave the NHS a high level of autonomy from direct government control.
The NHS Commissioning Board was first run by ex-Communist Sir David Nicholson; then by a former Labour councillor and ex-New Labour special advisor Sir Simon Stevens, who steps down at the end of July. Based on that trajectory, a cynical observer might suggest that in the distant future even a former Liberal Democrat could one day get the job.
But could the ‘NHS England’ top job go next to a prominent Conservative? And could it be the infamous head of the test and trace programme, Dido Harding?
Speculation among NHS ‘lifers’ about Steven’s successor began as soon as he announced his retirement in April. Stevens will certainly leave a gap in the organisation. His tenure is widely seen as successful, given the NHS has recently had the lowest increases in funding in its history. The NHS has also coped as well as possible during the Covid-19 pandemic: it adapted fast to the massive surge in demand for critical care provision for the sickest; and segued into the brilliantly successful roll-out of the vaccines procured by the Vaccines Taskforce under the leadership of Kate Bingham.
Sir Simon won funding increases for the NHS under every government administration he worked with. His mastery of his brief in front of select committees and interviewers was machine-like and his political skills are widely admired. He was a ‘golden boy’ hire for Cameron and Osborne, who could rarely resist an authentic Blairite and they rarely denied his requests for funding.
Stevens’ competence and savvy meant that most people outside the health world didn't spot the increasing underlying deficit in the NHS, nor the significant increase in waiting lists that were already truly bad before Covid-19 hit and are now the worst since records began, with nearly five million people waiting for treatment.
The fundamental structure of the NHS will be considerably different for Stevens’ successor as well. The White Paper which will form the basis of the government’s forthcoming Health Bill is largely based on legislative suggestions developed by the NHS under Stevens, but as I pointed out when I published an authenticated leak of the paper, there is a significant extra element.
Matt Hancock has added plans to ‘take back control’ of the NHS: the White Paper suggests giving the Health Secretary powers to directly intervene in the running of the NHS, service reconfiguration decisions and the ability to abolish arms-length bodies. This undoes a key part of the Lansley reforms which reduced the Health Secretary’s ability to intervene in the running of the NHS.
For ministers, explicitly taking back control of the NHS in this way looks courageous, given the NHS’s financial and performance challenges. Until the Health Bill is published, we won’t know whether there will be intervention thresholds or safeguards, to save a Health Secretary from herself or himself.
But it seems clear that the government would want the next leader of NHS England to be aligned with the current administration. Those in charge of the appointment are the chair of NHS England, former Conservative MP Lord David Prior and the Health Secretary, with a confirmatory veto for the Prime Minister.
A Conservative party supporter, such as Dido Harding, who is a Conservative Peer in the Lords, would clearly be a good fit. The fact that she is a a horse-racing lover like Matt Hancock wouldn’t do any harm either.
As for her experience in health? Dido Harding’s career has mostly been in retail, but since 2017 she has chaired NHS Improvement (formerly the provider sector regulator Monitor). She was also briefly involved with Geonomics England as an interim chair.
Harding came to public attention in May 2020, when the PM appointed her to lead the government’s Test and Trace programme. Boris Johnson promised that this service would be ‘world-beating’ by 1 June, but in reality, Test and Trace’s performance, particularly at contact tracing, was very poor for a long time.
In late September 2020, the Scientific Advisory Group on Emergencies found that Test and Trace was having only a ‘marginal impact’ on stopping Covid-19 transmission. In December 2020, the National Audit Office also found that ‘issues with implementation and potentially the initial choice of delivery model mean that it is not yet achieving all its objectives.’
And in March 2021, the Commons Public Accounts Committee concluded that while Test and Trace clearly had to be set up and staffed at incredible speed, there is still no clear evidence of the programme’s overall effectiveness; and it’s not clear whether its contribution to reducing infection levels can justify its ‘unimaginable’ costs.
According to the Sunday Times, Baroness Harding is considering applying for Stevens’ old job. And she conducted a long and punchy interview on BBC Woman’s Hour today, defending her record over Test and Trace.
Harding told listeners that she didn’t read the negative media coverage, and suggested that
“‘Expectations were set too high. This year, we’ve learned that Test and Trace is part of the response, but not a silver bullet for return to normal. It's not possible to do it with Test and Trace alone’.
Test and Trace has an allocated budget of £37 billion over two financial years (it may not spend all of this).
Will Harding apply now to be chief of the NHS, and if so, will she get the job? After this little publicity barrage, it would seem odd if she were not going to apply. And the current government does seems to have what the late Margaret Thatcher called a ‘one of us’ approach to public appointments – meaning Harding’s application would certainly have a high chance of success. At present, Baroness Harding looks to be more than a nose ahead in the steeplechase to replace Simon Stevens.