Health Policy Debate
9 August 2006
Four challenges for the new NHS chief executive
Health policy is tense at present with something of a stand-off developing between proponent and opponents of reform.
Tony Blair told the Labour Party Policy Forum it is inevitable a government in its third-term will have its critics. “What sustains a government at this point is self belief” [Go to note 1]. At the same time, a theoretically less hands-on Richmond House is busier than ever developing plans for local implementation. It must be an uncomfortable position, to be between the earshot of proselytising from No10 and angry complaints from the service that the approach is damaging and does not make sense.
In the absence of a shared and coherent strategy for health, commentators are always on the look out for signals to help them read the direction of travel. As the Guardian noted, of the many candidates mooted to become NHS chief executive many are relieved an NHS (and an English)man has been put in place. “There was resentment attached to the expectation that Tony Blair would seal his plan to turn the NHS into a competitive market by putting an American in charge”. Some interpreted the appointment as a sign the pace of reform might slow [Go to note 2], an accusation Nicholson was quick to dispel: “If anything I want reform to go faster” [Go to note 3].
Nicholson’s appointment had to be okayed by the Prime Minister with a selection panel included Dame Carol Black, Sir Alan Langlands and cabinet secretary, Gus O’Donnell [Go to note 4]. Presumably at the interview he told them what he told HSJ: that he sees a bigger role for private entrants who may even run DGHs.
Despite Nicholson’s tough talking, the Guardian’s John Carvel believes this NHS man ‘through and through’ will work well with the service. He suggests the appointment ‘fits with other signs that the government has begun to realise it cannot browbeat the NHS into a state of enthusiasm for reforms’ [Go to note 5].
The NHS Confederation chief executive Gill Morgan believes that David Nicholson faces four challenges: (a) “to deliver on the financial side”; (b) “rebuild a collegiate and collective spirit that makes people deliver”; (c) “improve clinical engagement in shaping the direction and politics”; (d) “we need to get a strategic vision, not just looking a couple of years ahead, but to the next four or five years”.