29 Jul 2021

Yesterday, Amanda Pritchard was named as the new CEO of NHS England. There has been no shortage of hopeful candidates to replace Lord Simon Stevens as NHS England CEO, but for the last year or more, most NHS watchers have rightly backed Pritchard as the likely successor.

There are two key reasons why she has been chosen. One relates to a key strength of Pritchard’s. The other, to a potential weakness.

The appointment is officially made by the Board of NHS England. In practice, it is a role agreed and approved by DHSC and the Prime Minister. Before the pandemic, there was interest in Government to appoint an external reformer to inject greater challenge, innovation and productivity into the NHS. But COVID has changed the priorities of the CEO role.

NHS recovery is now the central task. A multi-year task of reducing record elective waiting lists lies ahead in an NHS running at below normal capacity and more worried than ever about winter pressures only five months away. Some estimates suggest a quarter of all adults in England will soon be waiting for treatment. On top of this the NHS must execute a major structural reconfiguration of local organisations. And it is important to remember that the structural changes seek to make a strategic change in the mindset of the NHS – moving from a service that treats ill health to one focused on prevention.

Pritchard’s key strength is that she knows the NHS and the NHS knows her. As well as being established and proven in NHS England, one senior NHS England figure told Hanover recently that her experience as the former CEO of a major hospital trust is a crucial advantage in her ability to bring the service with her through the challenging times ahead. Stevens did not have this experience and many have forgotten his battles with the hospital sector in his early days as CEO, most notably over tariff changes. It took Stevens a while to establish the dominance that we have taken for granted. Importantly, NHS Providers, which represents hospital trusts, yesterday welcomed Pritchard’s appointment saying she “has a deep and strong connection with NHS frontline leaders”.

Now is not the time to shake up the NHS with an outsider. Health Secretary Javid said yesterday that NHS staff would “value her operational experience and steady hand”. The Government and the NHS both need a smooth transition and continuity, making Pritchard most attractive.

Pritchard’s other key attraction to Government is seen by some in NHS England as her weakness. She is not the experienced Whitehall campaigner and arm-twister that Stevens has been.

Hanover’s NHS England contact enthusiastically backed Pritchard but noted that it will mean a reduction in the organisation’s influence in Government. Simon Stevens sometimes frustrated Government by being better at politics than the politicians and winning extra funding for the health service as a result. When asked privately who the Government wanted as Stevens’ replacement, a senior No.10 contact recently told Hanover, “someone willing to accept less power”. Pritchard fits this mould and is unlikely to brief against the new Government powers in the proposed legislation or frustrate them in practice.

Some in NHS England will now wish to counterbalance Pritchard with a Chair willing to fight harder in Whitehall but, when Lord Prior’s term is up for renewal in October 2022, it is hard to see why Government would choose to replace him with someone who would cause them problems.

Pritchard is seen as the leader best suited to unite the NHS in a common and collaborative approach to its challenges, and to adopt a more compliant relationship with the NHS’s political masters.

We wish her every success.