Editorial Friday 9 July 2021: What the remaining NHS England leadership candidates must consider

It seems as if the candidate pool has reduced to three in the race to succeed NHS England chief executive Lord Stevens of Birmingham (the artist formerly known as Simon Stevens).

HSJ reports that NHSE deputy CE Amanda Pritchard, KPMG's Dr Mark Britnell and Leeds City Council boss Tom O'Riordan remain in the race.

(UPDATE: two more candidates are now understood to be in contention: an overseas health system leader, and ex-Amazon UK CE and ex-McKinseys Douglas Gurr. It is unclear how Mr Gurr joined the process, as I understand that his application was not sent in by the closing date. Asked about this, Russell Reynolds Associates, who are handling the recruitment for NHS England, stated that they do not comment on client matters. I have approached NHS England for their comment on this, and will put it here once received.)

The race itself is becoming comical at the shortlist interviews stage: it seems that candidates are to undergo a day of psychometric testing and 'Dark Traits' analysis.

This is frankly, one step away from using a combination of divining rods, homeopathy and phrenology to pick the next NHS boss.

Pseudo-science of this kind is clearly going to make a few more quid for those agencies advising this recruitment process, and it gives us all a much-needed good laugh. So I guess that's two upsides of it.

Each of the remaining candidates can do the job. Who is chosen will reveal what the main question facing the NHS is deemed to be by those running the process.

It would be simplistic to characterise these candidates: Amanda Pritchard as the activity delivery one; Mark Britnell as the public-and-private-experienced one; and Tom O'Riordan as there local government/system integration one. There's more to each of them than that, and none of them is a one-club golfer.

They are all smart people, and I hope that one key point is well-lodged in each of their minds as the approach the last stages of the process.

The point is implied in my first line, about "the race to succeed Lord Stevens". Because the likelihood of success is quite low.

The new waiting times data just out, and the current demand facing the NHS, as revealed by the Independent's Shaun Lintern and Manchester Evening News's Jennifer Williams, provide a perhaps Euro-2020s-obscured picture of a very real emerging NHS crisis.

The sack race

Put simply, none of these candidates should be applying if they think their career cannot survive the high probability of very publicly a) needing to resign, or b) being sacked.

Those are the two probable outcomes to taking over at NHS England - both now, and for the foreseeable future.

Given the scale of the backlog, there's insufficient time to deliver a meaningful performance recovery before the latest possible date for the next General Election.

Furthermore, there is Covid19 that the Government can cite as a reason for the NHS backlogs.

That is mostly nonsense, of course, as the data shows.

Covid has made matters worse, but they were already very bad. The Health Foundation showed that "before the pandemic, meeting the 18-week standard would have required the NHS to treat an additional 500,000 patients a year for the next 4 years – an unprecedented increase in activity, which looked unrealistic before COVID-19 and looks even harder now".

Like I say, nonsense. But this current Government's relationship with the truth is far more than socially distanced: the truth is something that happens to other people.

So they will try any lie going.

The danger is that the incurious average of people may fall for it.

So, were I any of those three candidates, I'd be keenly aware that the likelihood of getting the resources to sort out the backlog problem that's been many years in the making is slim. (There will be some extra resource, but very unlikely enough.)

That leaves it wide open for the Government to say, 'well, we put in the extra money, and the service didn't deliver, so I'm afraid we'll have to replace the person at the top'.

Unrealistic? Don't bet on it. You'd hope not to have to instinctively think that PM Boris Johnson would claim to have sacked Matt Hancock, right after insistently standing by him and calling the matter "closed", but that's what we're dealing with here.

Data and dates

Whichever of these candidates is chosen needs immediately to set a date by which they'll spell out the realistic resource implications and timescale for delivery for the politicians, the press and the public.

It should be done by mid-September. If they're smart, they'll rope in the IFS and the three main health think-tanks to agree the data and dates.

And they'll livestream it, with an audience of journalists to ask the questions.

The Government will, of course, hate this. And it's the one conceivable way for whoever is chosen to buy themselves the three things they haven't currently got: a) negotiating firepower, b) political air cover, and c) time.