Why Has Boris Johnson Appointed an NHS Manager With a Questionable Track Record to the Top of the Civil Service?

Sue Gray’s report into Partygate is coming out soon and the PM is announcing a big shake-up of the structure of the Civil Service by way of a pre-emptive defence against criticisms of chaotic management in 10 Downing Street, as the Guardian reports.

Under the shake-up, the Government announced changes that will “enhance the support that is offered to the Prime Minister and to the Cabinet”. The Cabinet Office will be split into two, with domestic policy oversight, national security and legislative units handed to No 10 under Jones. The remaining Cabinet Office functions including Whitehall changes and Civil Service administration will remain under the Cabinet Office permanent secretary, Alex Chisholm.

This raises the question: ‘Who is Jones?’ In April 2021, Samantha Jones was appointed the Prime Minister’s top adviser on NHS transformation and social care. 

It is perhaps unsettling news that an NHS management guru is now suddenly a permanent secretary under the beleaguered Simon Case, based in 10 Downing Street. She is the second most important Government official in the state, with a brief covering national security. As the Daily Mail reported:

She began her NHS career as a nurse at Great Ormond Street Hospital but quickly realised life on the wards was not for her. While still a trainee, she went to see the Chief Nurse at the London Children’s Hospital and declared she wanted to go into management. She later recalled: “I said, ‘I don’t know why I want to be a manager, but I’ve got four brothers. I’m too stroppy. I have to stand by my beds while the consultant does his ward round and I’m not allowed to speak until I’m spoken to – and I’m not having any of that.’”

The Mail interview goes on to say that her favourite book is Machiavelli’s The Prince, a 16th-century guide to ruthlessly obtaining and maintaining political power, perfect for life in the byzantine 10 Downing Street court. Her dream dinner party guests would include Hillary Clinton, Barack Obama, David Walliams and Nelson Mandela, so she will fit perfectly with Sir Michael Barber, the PM’s manager of ‘delivery’ and former close aide to Tony Blair – the Blairite tendency grows apace. So the NHS, a truly broken institution, is now the source of salvation for our nation’s administration, supplying top officials to Downing Street. Matthew Taylor, who is Chief Executive of the NHS Confederation, is a former political strategist to Tony Blair.

Ms. Jones was involved in a minor scandal when, as Chief Executive of Epsom and St Helier Hospital, she was involved in appointing her sister-in-law, Ruth Harrison, to a £50,000 a year job after Harrison, Chief Executive of Stoke Mandeville Hospital, had been criticised for her management of a hospital in which patients died due to poor infection control. Ms. Harrison also got a pay off of £140,000, which attracted criticism from MPs and the Tax Payers’ Alliance.

On the face of it, NHS management would seem the very last place for 10 Downing Street in its state of utter chaos to recruit an administrator. So who is Samantha Jones and why has she been propelled to the top of the Civil Service so fast? Her claim to fame appears to be that she was in charge of the implementation of the Vanguard programme of restructuring care in the NHS via new ‘care models’ between 2015 and 2017. 

This extremely open-ended, costly programme described itself in September 2016 as follows:

Between January and September 2015, 50 vanguards were selected to take a lead on the development of new care models which would act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system. Through the new care models programme, complete redesign of whole health and care systems were being considered.

Vanguards are local collectives which offer health care and which can experiment and develop new ways and models of provision.  

How might the effectiveness of Ms. Jones’s project be evaluated? With difficulty it seems, according to the Manchester University Evaluation Report of 2019. Referencing the 2018 National Audit Office Report, it says:

The recent NAO report (2018) suggests approximately £329m direct investment between 2015 and 2018 with an additional £60m on the Vanguard NCM programme, support and monitoring (including national and local evaluation and staff costs). However, support costs are approximate, as there is no clear accounting for the time of staff seconded from other roles in NHSE to support the programme.

The project clearly costs a lot of money, but is it worth it? This Manchester University report concludes that the project is muddled, to use lay language:

In terms of future policy making and planning we suggest that the multiple purposes underpinning the NCM Vanguard programme may have been problematic. For example, there is a tension between the need for ‘good news’ from a programme and the need to really understand in depth whether and how particular changes to services are actually beneficial. We have highlighted the lack of clarity over how the NCM Vanguard programme was intended to be disseminated and spread and shown a tension between approaches to ‘scaling up’ and ‘spreading out’. It may be useful for those involved with the NCM Vanguard support and evaluation programme to work closely with the team now responsible for supporting developing ICSs, with the explicit intention of considering whether and how the different local NCM Vanguard service models might best be implemented over a wider population. 

A major difficulty with the Vanguard project erupted with a threat of strike action by staff affected by one of the new Vanguard models introduced in Manchester. Unions warned that they could see support workers given potentially dangerous tasks like administering controlled drugs. They were concerned that the Vanguard new model would involve “piling duties on to unqualified workers”.

Vanguard has been very expensive and is hardly a storming success story. While Ms. Jones may have been an effective hospital chief executive, her record doesn’t really explain why she is now a permanent secretary atop the British Civil Service and a close advisor to the PM in 10 Downing Street across all policy areas. Just what criteria is Downing Street using to make these appointments?

Dr. Timothy Bradshaw is a retired Lecturer in Theology at the University of Oxford.

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