Biggest headache for the NHS boss is his own plan | Denis Campbell

Who would be Simon Stevens? The job he takes such pride and purpose in has recently got a lot harder. Colleagues of NHS England’s chief executive say Downing Street’s preoccupation with Brexit means officials are letting him get on with his self-declared mission of transforming the health service in England. But that is the only good news about his relationship with Theresa May and her advisers.

Until July, Stevens worked and got on well with a prime minister who did at least protect NHS funding while cutting almost everything else – David Cameron. But he now has the misfortune of dealing with May, whose curious lack of interest in the true state of the health service is almost as worrying as her capacity for self-delusion over it.

Unprecedented poor waiting times for A&E care, planned operations, ambulance responses to 999 calls and delayed transfers of care from hospital? Just normal winter pressures. Record numbers of A&E units having to divert patients elsewhere and NHS trusts being forced to declare an alert because they can’t cope? There’s only the odd problem here and there – and it’s all lazy GPs’ fault anyway. Too little money to do the job properly? The £10bn is more than the NHS asked for – an outright lie. Rarely have a prime minister and NHS boss spoken from such different scripts.

Stevens is operating in the chilliest political climate any boss of the NHS has faced since the tailend of John Major’s time in office. Will May seek to oust him? Maybe, though a vengeful Stevens publicly telling it like it is could do her incalculable damage. The sheer brio of his evidence to the public accounts committee last month – a masterclass in speaking uncomfortable truth to power – does not suggest a man who would go quietly.

But Stevens’s biggest headache is not the “winter crisis”, cancelled cancer operations or financial failure. Rather, it’s his NHS Five Year Forward View, and the lack of realisation of its ambitious goals since its launch in October 2014.

Stevens may have made bold speeches promising a brave new NHS world by 2020 through new models of care, accountable care organisations and innovative sustainability and transformation plans (STPs). But reality has failed to match rhetoric by a wide margin. Yet next month sees a “national Five Year Forward View delivery plan for the rest of the parliament” – a progress report, albeit of only limited progress.

Stevens will formally green light the metamorphoses of a small number of the 44 regional STPs into “integrated organisations”, which ultimately dissolves the split between commissioners and providers of healthcare. They will probably include those covering Birmingham and Frimley in Surrey. The cadre of belated pioneers will get extra money and staunch support to “reshape what they’re doing” in a dramatic way. He will bat away questions about what became of all the other areas’ plans – still mere “proposals”.

Stevens hopes that even the modest progress made so far in transforming the NHS will persuade May & Co that – given money and political backing – more integrated services between GPs, acute hospitals and social care will deliver an NHS that is able to cope with the pressures. But will May, bereft of her own alternative vision of the health service, see the wisdom of backing the man who dared to challenge her over it so publicly?

Biggest headache for the NHS boss is his own plan | Denis Campbell