PM tells Simon Stevens he will be personally responsible for how well GPs and hospitals in England cope, leaving allies to fear he is being lined up as ‘fall guy’

Theresa May has made NHS boss Simon Stevens personally responsible for ensuring the health service does not end up in a crisis this winter, amid renewed tension between him and ministers.

The prime minister told Stevens that he would be held accountable for how well hospitals and GP services in England cope at a tense, previously unreported, meeting at Downing Street in September.

Allies of the NHS England chief executive fear he is being lined up as “the fall guy” if a surge in seasonal illness this winter leaves hospitals struggling to meet sudden extra demand for care.

Relations between May and Stevens, who was appointed by David Cameron, have become increasingly strained. Last week the NHS chief executive launched an attack on government underfunding at a conference and said the service should receive the extra £350m a week promised by Leave campaigners in the EU referendum.

“The prime minister made it very clear that Simon Stevens was personally responsible for and accountable for the NHS’s performance this winter,” a source said.



“There was a long pause, as the enormity of this sunk in. He had to accept it because she was making it clear that he was in charge of winter. He couldn’t say no,” the source added. Colleagues of Stevens believe that it is unfair and unrealistic of May to expect the head of the service to be responsible for its entire performance, especially given its tight budget and understaffing.

Hospitals came under huge strain last winter, with dozens forced to go on “black alert” – a declaration that they could not cope with the number of patients needing care. That crisis has prompted unprecedented efforts by NHS England, NHS Improvement and Public Health England to ensure the scenes of chaos are not repeated this winter.



Allies of Stevens believe this joint working shows that maintaining safety and quality of care during winter involves collaboration, and no single NHS agency can do everything required, so it is wrong to expect Stevens to take the blame if things go badly.



May’s decision appears to take health secretary Jeremy Hunt, who has faced tough questions in recent winters, out of the firing line if problems this winter lead to a blame game. Last winter the number of patients waiting on trolleys in A&E to be admitted to hospital was so high that the British Red Cross declared it a “humanitarian crisis”, which caused huge panic in the government.

The 7 September meeting was attended by May, Stevens, her health adviser Dr James Kent, Chris Wormald, the Department of Health’s permanent secretary, and Jim Mackey, the chief executive of NHS Improvement, the NHS’s financial regulator.

She told Mackey that he would not be responsible for NHS performance over winter because he was soon to step down and then told Stevens that he would therefore be in charge. Five days later, Stevens warned that hospitals should brace themselves for a difficult winter because Britain was likely to experience the same “heavy flu season” that had been putting such strain on health services in Australia and New Zealand.

Bosses of NHS trusts and doctors groups are acutely anxious that bed shortages, nurse and doctor shortages and their inability to discharge patients because of inadequate social care could cause what the Royal College of Surgeons has predicted could be a “winter of woe”, especially if a major flu outbreak does occur or there is a cold snap. The NHS is putting £237m into the biggest ever flu vaccination campaign in an attempt to limit the numbers being affected by it in coming months.

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said any attempt to make one person responsible for winter performance over the winter demonstrated a lack of knowledge of how the NHS worked. “The idea that a single figure can be personally in charge of the performance of a system as large and complex as the NHS is one of the most persistent and damaging myths in healthcare.

“It is indisputable that the NHS is facing a yet another difficult winter. But whether or not it experiences a full-blown crisis will depend largely on unpredictable events, like a sudden outbreak of flu or norovirus. What is clear is that, seven years into austerity, the pressure on the system is immense, making the health service much less resilient to these kinds of events than is comfortable,” he added.

No 10 regard Stevens’s sharp critique last week of current and planned levels of NHS funding in England as “unhelpful”, an insider said. In his speech, he said that the health service would need £20bn-£30bn more than the £125bn a year it currently receives, to take it up to the level of funding in Germany and France, and £4bn more next year alone otherwise it would have to let delays for treatment lengthen and abandon ambitious plans to improve cancer and mental care.

A source familiar with Treasury thinking said: “The Treasury aren’t happy with him and don’t like what he did in that [speech]. They don’t trust him to run the NHS properly and think his track record is pretty dismal, like letting hospitals’ deficits balloon to £2.5bn and talking a lot about how the delivery of care to patients need to change but not actually changing very much of it.”

NHS England declined to comment.