Job description shows scale of ‘Nicholson challenge’

NHS England has given the clearest hint yet of what the post-Sir David Nicholson future might look like, with the publication of the job description for the role of its chief executive once Sir David stands down in March 2013 (although there have been some suggestions that this could be sooner if an appointment has been made and a handover of responsibilities completed). Not unlike the football transfer window, rumours and speculation abound as to who the next chief executive might be. Names banded about include Don Berwick from the US, Mike Farrar of the NHS Confederation, and the likes of Mark Britnell or Simon Steven from the private sector (although in Dr Britnell’s case it is worth remembering that prior to his departure for KPMG he had spent many years in the upper echelons of the NHS)

NHS England Chair Professor Malcolm Grant has commented very publicly that Sir David’s successor will not necessarily come from the UK, and the stage could potentially be set for a Mark Carney-escue appointment. But, as The Independent has noted, this is not the most interesting issue around Sir David’s successor. What the job description demonstrates is that first and foremost NHS England will be after a chief executive who can ensure the NHS lives within its means, ramming home recent fears that the health service could face a £30 billion funding gap within seven years.

That the emphasis of the chief executive’s role should be on achieving and delivering value for money – superseding even prior experience in healthcare – demonstrates very clearly the scale of the financial reality (ironically referred to as the ‘Nicholson Challenge’) in which the NHS finds itself. There is no longer any suggestion that the NHS can be propped up by ever-increasing amounts from the public purse: in fact this demonstrates more than ever the change in attitudes within the NHS over recent years to acceptance that throwing money at a problem is in itself no solution.

It is anyone’s guess who Sir David’s successor should be, but the job description should leave them in no doubt as to the scale of the challenge they will face – particularly when quality of care remains such a high priority in the political and public agenda. Whoever the next NHS England chief executive may be, they will face an unenviable task of making savings while maintaining quality – all set against a backdrop of the public realising the fallibility of the health service but remaining suspicious of service change.


Chris Rogers