EHI doesn’t do speculative pieces about the rumoured runners and riders for top NHS jobs. There’s far too much scope for error and such pieces are usually about as thorough as reporting celeb tweets.

But if we were to make an exception and speculate on who is in line to replace Sir David Nicholson, it might run as follows…

The race is on

With Sir David Nicholson set to step down as chief executive of NHS England in March, the race is on to land the one of the top jobs in the public sector.

To some it may look like a poisoned chalice. With the full magnitude of the Nicholson challenge only just becoming apparent, the odds looked stacked against Sir David’s successor lasting the seven years that he has managed at the top of the health service.

The extent to which Sir David has been publicly vilified for a succession of trust scandals and the melt-down of the health service’s regulatory regime is also said to be deterring some possible candidates.

But the ‘head of the NHS’ remains one of the most sought after jobs in the UK and internationally; so its potential to make or break careers and reputations is part of the deal.

The post-holder still has the potential to have a very significant impact on healthcare in England and to act as the high priest of the country’s secular religion. As a bonus, they also tend to be a shoe-in for a knighthood or ermine cloak.

Timmy Time?

Many of the candidates being bandied about have a strong data background. With money getting ever tighter, the importance of information as a driver for health service improvement, and IT as a vehicle for doing more with less, should make that a distinct asset.

EHI has been told that among the candidates said to be campaigning behind the scenes is NHS England’s national director of patients and information, Tim Kelsey.

The former government transparency tsar, McKinsey consultant, Dr Foster co-founder, journalist and jazz musician is a man of many parts.

He wants to re-invent the NHS as a social movement, driven by a fervent belief in the power of transparency. Kelsey has risen far and fast by tapping into the information agenda that is now so critical to the new regime.

He has bags of restless, visionary energy and drive and some key political support. But he is not famed as a completer finisher or as a man particularly interested in detail.

Sources suggest that Kelsey is very highly regarded by health secretary Jeremy Hunt, but far less favoured by Chancellor and – more importantly in this context – Conservative party election strategist George Osborne.

Osborne wants health kept quiet until the May 2015 general election; and a high profile, headline grabbing new head of NHS England doesn’t obviously fit with that plan.

New Labour survivors

Mike Farrar, chief executive of the NHS Confederation, is thought to be more favoured by Osborne, and is widely seen as a safer pair of hands. As a candidate, Farrar would be far less controversial, as a thoughtful leader with deep experience of NHS management and culture.

He gets the power of information – he did a lot to shift board attention towards IT and innovation in the North West and was an early supporter of clinical leadership for IT projects – but he remains firmly rooted in the health service. The same strengths are cited by opponents as weaknesses.

Another NHS veteran of the Labour years who is thought to be in the frame is Mark Britnell, best known for his advocacy of ‘world class commissioning’. With NHS England created to make clinical commissioning work, it’s an appointment that would make sense.

Britnell, however, would likely have to take a big pay cut if he were to be offered and to accept the job – he is currently a high earning VP healthcare for the ubiquitous KPMG. Sources indicate that Britnell’s perceived Labour-leaning affiliations may also weigh against him.

How about a doctor?

Another possible candidate, but one who may already have ruled himself out of the running, is NHS England’s chief medical officer Sir Bruce Keogh.

The cardiac surgeon, who is highly regarded as a clinical leader, pioneered the publication of heart surgery data, promoted the wider publication of surgical data, and has recently stepped into the row over failing trusts.

Just last week, he published a report on 14 trusts that were outliers on the NHS’ current mortality statistics, promoting the idea of a new ‘avoidable deaths’ indicator and a whole new method of inspection for the CQC in the process.

Sir Bruce is said to be attractive to the government, as he would be the first doctor ever appointed to lead the NHS. But he may not want to place himself in the same – very public – firing line that Sir David has found himself in.

The furore over Leeds child heart surgery data gave a taste of what might follow. The adverse political commentary and newspaper punditry that abused his carefully worded trust review last week will have done little to reassure him.

What about a nurse?

Another clinical leader said to be in the mix is Sir Jonathan Michael, chief executive of Oxford University Hospitals NHS Trust, and formerly head of BT Health when it was responsible for rolling out Cerner Millennium across London and parts of the South.

Before that, Sir Jonathan was chief executive at Guy’s and St Thomas’ NHS Foundation Trust, just across the river from Westminster. As such, he’s a canny operator who survived the NPfIT debacle with his reputation intact; which is no mean feat.

A more radical approach, and one which would go some way to address the impression the government is anti-nursing, would be to appoint a senior nurse to lead the NHS.

One name that has been mentioned recently is Dame Julie Moore, the highly regarded chief executive of University Hospitals Birmingham NHS Foundation Trust.

Under her leadership, the trust has become a national leader in clinical IT in areas such as e-prescribing; and an intriguing critic of the limitations of those controversial mortality measures.

Her potential appointment would be a double first: not just the first nurse, but the first woman to lead an organisation that employs far more women than men.

Then again, the coalition might fancy going back to its ‘big society’ rhetoric by making an appointment from the third sector. An outside bet, with a very strong set of patient credentials, is Ciarán Devane, chief executive of Macmillan Cancer Support.

We don’t speculate, but…

Of course, the government may decide to look outside the NHS when it comes to finding a new leader for NHS England. But its predecessor looked hard for an outsider before Sir David was appointed, only to see its much-vaunted private sector candidates fail to materialise or fall away.

The pressure of the job – for the relatively low pay – makes a wiley insider, more or less acceptable to the service, politicians and the public, a better bet.

What is certain is that whoever takes over at the helm faces an infinitely more difficult legacy than the one Sir David inherited back in 2006; although even then the NHS was coming towards the end of its historic budget increases.

Their challenge will be to drive unprecedented efficiencies, redesign care, and improve variations in outcomes. To have any hope of succeeding, they will have to transform the health service into a digitised industry that harnesses information and supporting technologies as some of its most strategic assets.

It would be good if Sir David’s successor had at least some experience of doing that. But as we said at the outset, EHI doesn’t bet on leadership races…

Who else with an exceptional skills in: information, clinical care, patient empowerment, commissioning, senior management, proven innovation, leadership – plus political savvy – should be on the short-list to become the next head of the NHS? Please make your suggestions below.