A UnitedHealth Group executive is leaving to run the United Kingdom's National Health Service, a long-heralded institution that in some parts of the country is facing a crisis of finances and quality of care.
UHG global health president Simon Stevens, a part of efforts to move the insurer away from the fee-for-service model during the last decade, will be taking over the role of chief executive of NHS England in April, just as a new reform law opens the country's healthcare system to more privatization.
"The next five years are going to be extremely challenging for the NHS," Stevens said in a media statement, "but compassionate high quality care for all is as vital as ever...at a time when the stakes have never been higher."
A U.K. native and former advisor to Prime Minister Tony Blair, Stevens currently oversees UHG's international businesses, the Center for Health Reform and Modernization and the Optum Institute, joining the company's Europe division in 2004 after working at the NHS and at the New York City Health Department.
As part of a mandate launched by the current NHS England chief executive and a restructuring law passed last year, the NHS is trying to reduce spending by $32 billion (£20 billion) through 2015, and cuts are being targeted across a number of areas, including billions in hospital funding and an $80 million (£50 million) specialized services innovation fund.
"There is an urgent need for consensus about the future challenges facing the NHS, if we are to be able to effectively put in place the actions needed to provide solutions," said Dean Royles, the head of NHS Employment and interim chief executive of the NHS Confederation, in the media release.
The NHS was left in the midst of a soul-searching after an ongoing public inquiry into a hospital in Stafford, overseen by the Mid-Staffordshire NHS Hospital Trust, attributed poor standards care to as many as 1,200 unnecessary deaths between January 2005 and March 2009, especially for palliative and end-of-life patients.
The report found hundreds of cases of neglect, with patients left dehydrated, unwashed, unable to access bathrooms, discharged prematurely or misdiagnosed. The inquiry blamed many of the problems on "an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities."
There was "a low morale amongst staff" who feared retribution amid reports of whistleblower gagging orders, the inquiry noted. "Management thinking during the period under review was dominated by financial pressures and achieving (foundation trust) status, to the detriment of quality of care," the report said, referring to the leaders' goals of transitioning Mid-Staffordshire from a Hospital Trust to a more autonomus Foundation Trust under the NHS.
Mid-Staffordshire has come to represent the NHS at its worst, and its links to current NHS leadership may have something to do with a relative outsider being called to lead the organization.
Current NHS England chief executive, Sir David Nicholson, oversaw the Mid-Staffordshire NHS Foundation Trust in the mid-2000s, presiding over part of the time plagued by high death rates, and he later helped draft the NHS's financial savings goal of $32 billion (£20 billion) by 2015.
UHG's Stevens is coming to lead the NHS England as it oversees outsourcing and also regulation, amid public demand for more transparency from the country's hospitals. Stevens has described himself as an advocate for patient choice and shared decision making, and one of his main challenges may be finding sustainable long-term care policies -- a challenge for the U.S. government and much of Europe as baby boomers age.
The NHS's controversial Liverpool Care Pathway for the Dying Patient introduced in the late 1990s is being phased out over the next year, and regional NHS trusts are designing contracts open to bid by public and private providers.
In the central U.K. counties of Cambridgeshire and Peterborough, local health commissions recently announced of a £700 million contract for health services in elder and palliative care, with similar contracts across the country being designed by commissions run by general practitioners.
Stevens said he is voluntarily taking a 10 percent pay reduction, set to earn about $305,000 (£189,900) in the first year, to reflect "NHS spending pressures."