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From 2004 to 2014 Stevens was a senior executive at UnitedHealth Group. Initially appointed president of UnitedHealth Europe, he became CEO of UnitedHealthcare's $30 billion Medicare business, and then corporate Executive Vice President and president of its global health businesses spanning the Americas, Europe, Asia, and Africa. He also was a director of Brazil's largest hospital group AMIL.
He was instrumental in establishing a non-profit institute to publish information about inefficiency in the US health system. These data proved that contrary to prior research mainly using Medicare data, cost differences in the working age population were a result not mainly because of differences in service utilisation but also because of market pricing power by hospitals.
As the NHS England CEO, he is directly accountable to Parliament for management of £120 billion of annual NHS funding. He frequently gives evidence to the Public Accounts Committee, the House of Commons Health and Social Care Committee, and other Parliamentary committees. He has used the statutory independence of NHS England to speak openly about NHS funding and reform. In January 2019 he welcomed new figures from the Office for National Statistics showing that NHS productivity in England has been rising at 3%, treble the performance of the overall UK economy.
On his return to the NHS, The Guardian reported one health expert as saying "He's coming back to a pay cut [and] the mother of all messes". Stevens' own assessment was that "For the NHS the stakes have never been higher. The global recession has meant the NHS facing its most sustained budget crunch in its history. Service pressures are intensifying, and longstanding problems are not going to disappear overnight." Stevens said his aim was to "Think like a patient, act like a taxpayer." As of 2015, Stevens was paid a salary of between £190,000 and £194,999 by NHS England and each year he has opted for a voluntary £20,000 pay cut. According to Fraser Nelson, hiring Stevens back to run NHS England was one of the cleverest moves that David Cameron made because he "knows more about NHS problems and market solutions than any man alive". During the 2019 General Election campaign while the Labour Party said they would generally not comment on the appointments of public officials, they stated they have a "good relationship with Simon Stevens and respect him." In March 2019 it was announced Stevens would also lead the hospital regulator, NHS Improvement, effectively merging it into NHS England.
He was responsible for the Five Year Forward View produced by NHS England in October 2014. This marked the beginning of a major shift in how NHS care is delivered, in contrast to NHS policy since 1991. Instead care is increasingly being redesigned to achieve what Stevens labelled the "triple integration" of primary and specialist care, physical and mental health services, and NHS and social care. He has however recently challenged the longstanding assumption that this will mean there is a need for fewer hospital beds.
Stevens has also prioritised the modernisation of NHS primary care, mental health and cancer care having commissioned an independent national taskforce led by Sir Harpal Kumar the chief executive of Cancer Research UK. Breast cancer deaths have subsequently fallen faster than in other large European countries and outcomes are estimated to have caught up with or surpassed the European average. In 2015 he commissioned the independent Five Year Forward View for mental health chaired by Paul Farmer the head of MIND. He subsequently directed that each year local mental health spending must rise faster than overall NHS funding growth. Given increasing concerns about young people's mental health and eating disorders, he voiced concern on the BBC's Andrew Marr show about cosmetic surgery adverts during ITV's Love Island series. Shortly after, ITV's chief executive agreed to reconsider the ads, and the Advertising Standards Authority went on to ban them. He has suggested that social media companies might be asked to contribute to funding improved mental health support for young people. He has announced a dedicated confidential national mental health support service for NHS doctors.
While supporting expanded health training opportunities for UK workers, he has backed ongoing selective international recruitment in the NHS. In October 2015 speaking to the Institute of Directors at the Albert Hall he queried why ballet dancers but not nurses were on the Home Office's 'shortage occupation list. A week later the government added nurses to the list. He also led the introduction of an NHS Workforce Race Equality Standard to track and improve the experience and fair treatment of Black, Asian and Minority Ethnic Staff across the health service. Stevens supports a greater role for the voluntary sector and volunteering in the NHS, as a complement to the work of NHS staff.
Stevens has championed giving local communities more control over national budgets, including stronger 'Devo Manc' regional powers for Greater Manchester. He has argued for the importance of social care. In October 2018 he pledged up to £50 million for extra NHS support for the community affected by the Grenfell Tower fire. The Local Government Chronicle ranked him the most powerful figure in local government.
Prevention and public health
Stevens argues that "obesity is the new smoking" and has pushed for greater NHS, family, business and government action to tackle it. Stevens initiated NHS England's work with local authorities and developers to 'design in' health promoting built environments. These are now designated 'NHS healthy new towns'. He launched the obesity-reducing NHS Diabetes Prevention Programme and later backed its national expansion. He has championed NHS work to cut sugary drinks and junk food from hospitals, and suggested there should be a national sugar tax. In March 2016 Chancellor George Osborne announced a tax on sugary drinks.
He has drawn attention to the growing problem of gambling addictions, and the predominance of sports-related gambling promotions. The NHS has opened new specialist clinics which Stevens argued the industry should contribute to funding. Shortly after Stevens' criticism, the six largest gambling companies announced a tenfold increase in their industry contributions to services for people affected by gambling.
Stevens has drawn attention to online sources of misinformation about vaccine safety. He has noted that "although nine in ten parents say they support vaccination half of them say that they have seen fake messages around vaccination on social media," and "if parents are being told that their children shouldn't be vaccinated, it's as irresponsible as saying 'don't tell your children to look both ways before they cross the road on the way to school". He called on social media sites to take action against misleading and untrue health claims. Both Instagram and Facebook subsequently agreed to do so.
In response to rising knife crime, Stevens appointed trauma surgeon Martin Griffith to lead the NHS' work on violence reduction, educating children about the consequences of stabbings, alongside youth workers helping victims of gang crime while they are still being treated in hospital to help break the cycle of violence.
On climate change, he told the Royal Society of Medicine that "We have over 2,000 GP surgeries and hospitals located in zones with poisonous air [and] Public Health England estimates [air pollution will lead to] about 2.4 million cases of avoidable illness between now and 2035. We've already got more respiratory problems than the rest of Europe and according to the Royal College of Physicians up to 40,000 deaths may be associated with this pollution." For these reasons Stevens argues that "The climate emergency is a health emergency, and we, the NHS, as the single biggest organisation across this country are both part of the solution and part of the problem. We are 40% of public sector emissions, and although we have reduced our carbon footprint by around a fifth over the past decade, we've got to make major changes if we're going to help this country become carbon net neutral."
He has also argued that the NHS - as the largest employer in Britain - is an 'anchor institution' in many local communities, and so needs to "get more creative in developing staffing and clinical models that will enable us to sustain services and consider second and third order effects in terms of jobs and economic impact and social cohesion".
NHS funding and Brexit
Stevens has argued that "One of the problems with NHS funding over the last 70 years has been its volatility. So, we bounce off the banks between boom and bust and that makes it very hard to plan services." In November 2017 Stevens gave a high profile speech making the case for a return to NHS funding increases in line with historic norms and independently assessed requirements. He did so against the backdrop of a Vote Leave poster which had promised £350 million a week for the health service and which, he said, the "public want to see honoured". His call was widely supported both inside the NHS and outside it, ranging from Brexit-supporting Jacob Rees-Mogg to the Remain-supporting general secretary of the TUC.
In June 2018 - just ahead of the NHS' 70th Anniversary - the Prime Minister Theresa May announced extra funding for the NHS worth an average real terms increase of 3.4% a year, reaching £20.5 billion extra in 2023/24.
On 7 January 2019 Stevens launched the NHS Long Term Plan, drawn up with patient groups and NHS clinicians. It set out how the NHS will use its extra funding to redesign care and improve outcomes over the decade ahead. The Prime Minister spoke at the launch giving government backing to the plan.
In drawing up the NHS Long Term Plan, NHS England was also asked by the cross-party House of Commons Health and Social Care Committee, and by the Prime Minister, to make recommendations on possible changes to health legislation. Stevens came forward with proposals to substantially amend the government's previous 2012 legislation. A wide range of stakeholders called for an NHS Long Term Plan including the Age UK, Macmillan Cancer, the British Red Cross, RCN, Unison, the Medical Royal Colleges, the Kings Fund, NHS Providers, the NHS Confederation, the Local Government Association, Alzheimers Society, British Heart Foundation, Diabetes UK, the Stroke Association and the Patients Association. This letter specifically called for the removal of Section 75 of the 2012 Health and Social Care Act. The new government of Boris Johnson announced in the Queens Speech of 14 October 2019 that it would back the Long Term Plan, legislate for the £20.5 billion real terms funding increase, and introduce legislation to give effect to the NHS's recommended legal changes.
Stevens proposed - and NHS England then established - an 'NHS Assembly' to help steer implementation of the NHS Long Term Plan. It comprises a diverse range of stakeholders including national and local patients' groups, NHS staff and clinical experts.
Research and innovation
Stevens led action to stop NHS funding of homeopathy, on the grounds that "There is no robust evidence to support homeopathy, which is at best a placebo and a misuse of scarce NHS funds." NHS England was then sued by the British Homeopathic Association who argued that Stevens' criticisms, including on the BBC Radio Today programme, prejudged its public consultation. The High Court dismissed the BHA challenge, and backed NHS England.
"As a nation we need to pursue three goals simultaneously. First, we must actively support new discovery and further development of innovative treatments and care. Second, we have no choice other than to drive value and affordability across the NHS if we're going to create headroom for faster and wider uptake of important new patient treatments. And third, in the run-up to Brexit we need not only to secure - but enhance - our vibrant and globally successful UK life sciences sector."
He has pushed to deploy AI and Machine Learning in the NHS and NHS England will be hosting a new £250 million NHS AI Lab.
Stevens has actively promoted genomics, and cell and gene therapies on the NHS. In Autumn 2018 he announced that the NHS had become the first health service in Europe to negotiate approvals for newly licensed breakthrough CAR-T cancer therapies.
Stevens is critical of homeopathy, which he maintains is "fundamentally flawed". Stevens does not want the Society of Homeopaths to be reaccredited. Stevens stated, "This is a vital issue at a time when there is a rise of mis-information about vaccines - some of which is apparently promoted by homeopaths - and which poses a significant danger to human health." Stevens added "Anything that gives homeopathy a veneer of credibility risks chancers being able to con more people into parting with their hard-earned cash in return for bogus treatments which at best do nothing, and at worst can be potentially dangerous," he stated.
Since becoming NHS England CEO he has given lectures and speeches at the universities of Oxford, Cambridge, Durham, Exeter, London, Birmingham, York, Manchester, Southampton, Newcastle, and previously at Harvard, Yale, and NYU.