Britain’s National Health Service, once described as the closest thing the country has to a national religion, has anointed its latest prophet. Simon Stevens is to take over as chief executive of the sprawling state behemoth that is one of the world’s biggest employers.

英国国民健康服务体系(NHS)曾被称为“英国人拥有的最接近国教的东西”。最近NHS刚刚任命了新掌门人——西蒙·斯蒂芬斯(Simon Stevens)即将出任这只国有巨兽的首席执行官。NHS是全球最大的雇主之一。

At first glance, 47-year-old Mr Stevens is a surprising choice as chief executive of NHS England. The service regards itself as the proud antithesis of American for-profit healthcare. Yet Mr Stevens has spent close to a decade as a senior executive with UnitedHealth Group, a US healthcare company.

乍看之下，47岁的斯蒂芬斯被选为NHS首席执行官令人意外，因为NHS自认与美国以盈利为目的的医疗服务体系完全不同，并以此为荣，而斯蒂芬斯曾在一家美国医疗服务公司——联合健康集团(UnitedHealth Group)——担任近十年的高管。

Mr Stevens was also formerly active in the Labour party, serving both as a local councillor and as a special adviser on healthcare in Tony Blair’s government. Yet a Conservative prime minister and health secretary have entrusted him with control of a significant chunk of the service’s ￡100bn annual budget – just as a general election approaches in which their stewardship of the NHS will become an increasingly potent issue.

斯蒂芬斯以前在工党也颇为活跃，他当过地方议员，在来自工党的前首相托尼·布莱尔(Tony Blair)执政时期还担任过医疗服务政策方面的特别顾问。然而，现在来自保守党的首相和卫生大臣委托他管理NHS每年高达1000亿英镑预算中的一大部分资金——随着英国大选临近，对NHS的管理将成为一个日益重要的问题。

That the coalition has chosen to overlook such cultural dissonance says much about both Mr Stevens’ reputation and the scale of the problems besetting the health service. He succumbed to a wooing operation by Prime Minister David Cameron that was organised by Sir Jeremy Heywood, the government’s most senior civil servant and fixer. It was Sir Jeremy who assured an initially sceptical prime minister that Mr Stevens’ reforming credentials transcended party divides.

英国联合政府选择忽视这些文化上的差异，在很大程度上说明了斯蒂芬斯的名声之佳和NHS所面临问题的严重性。在首相戴维·卡梅伦(David Cameron)的示好和杰里米·海伍德爵士(Sir Jeremy Heywood)的实际运作下，斯蒂芬斯答应接手NHS。海伍德爵士是卡梅伦政府最资深的公务员，也是解决问题的一把好手。正是海伍德爵士打消了卡梅伦最初的疑虑，让他相信斯蒂芬斯的改革经验比党派分歧重要得多。

The NHS is in need of intensive care. A succession of scandals has blighted its reputation for both quality and managerial competence. This week it emerged that millions of pounds have been paid in severance settlements to staff made redundant during a much-criticised structural shake-up. Some were later rehired to successor bodies with tellingly similar remits.

NHS需要“重症监护”。连番的丑闻损害了它在质量和管理能力上的名声。本周有消息称，在实施饱受批评的结构性改革期间，NHS为遣散冗余雇员，支付了数百万英镑。部分人又重新进入后来成立、显然具有类似职责的机构工作。

Looking further ahead, the NHS will need to meet a remorseless rise in demand with what is highly likely to be a much tighter budget. Friends say Mr Stevens deliberated hard about the job, which meant not only a big salary drop but moving his family, including his US-born wife and two school-age children, from a comfortable life in Minneapolis into an unforgiving spotlight.

从长远来看，NHS将需在预算极有可能大幅收紧的情况下，满足需求持续不停的增长。朋友们表示，斯蒂芬斯对这份工作斟酌再三，因为这不仅意味着薪水大幅下降，而且他还得举家（包括美国妻子和两个正处于学龄阶段的孩子）从生活舒适的明尼阿波利斯搬到英国，面对很难应付的公众。

A comprehensive school boy from Birmingham, he entered the NHS in 1988 as a graduate trainee after studying at Balliol College, Oxford. Roy Lilley, a former senior NHS manager who became a close friend, first encountered him in the 1990s. “He was bright, attractive and charming. He didn’t suffer fools gladly but he set an enormous example by his own standards. I remember quietly thinking: ‘he’s too good for the NHS’, which is a terrible thing to say but he was just in a class of his own.”

斯蒂芬斯在伯明翰念完综合中学后，进入牛津大学贝利奥尔学院(Balliol College, Oxford)攻读，1988年毕业，进入NHS实习。NHS前高级管理人员罗伊·利利(Roy Lilley)在上世纪90年代认识了斯蒂芬斯，后来两人成为密友。利利说：“他聪明、富有魅力。他不会乐意跟傻瓜相处，但他按自己的标准树立了榜样。我记得自己曾私下认为：‘他太适合NHS了，’这样说有些绝对，但他就是独一无二的。”

Those who have worked closely with him say it is hard to overstate his influence on health policy during the Blair years. As special adviser to Alan Milburn, health secretary for four years from 1999, and later to the prime minister, he was instrumental in the shibboleth-shattering decision to turn to the private sector for additional capacity and a bracing injection of competition.

与斯蒂芬斯共事过的人说，在布莱尔担任首相时，他在医疗卫生政策方面可谓举足轻重。1999年至2003年阿兰·米尔本(Alan Milburn)担任英国卫生大臣时，斯蒂芬斯是米尔本的特别顾问，后来又担任布莱尔的顾问。英国政府改革陈规陋习，决定借助私人部门来增加医疗资源，向医疗服务体系引入竞争，斯蒂芬斯在其中发挥了很大作用。

Opening privately run surgical treatment centres and even sending some patients abroad for treatment broke up the NHS monolith. Waiting times tumbled and many of those rich enough to have flirted with private healthcare flocked back.

开办私人经营的外科治疗中心，甚至将一些患者送往国外治疗，由此打破NHS这个僵化而庞大的体系。候诊时间明显缩短，许多转向私人医疗服务的有钱人又重新使用NHS的服务。

Cultured and urbane – “able to talk about art and music”, says one associate – Mr Stevens would brook no opposition from the traditionally sclerotic health service bureaucracy. He secured a 30 per cent reduction in the number of civil servants, making health the only department to meet a key cost-saving target.

斯蒂芬斯非常有教养，温文尔雅——据一位同事说，“能够与人讨论艺术和音乐”——他不会容忍来自这个历来僵化的医疗服务官僚体系的反对。他推动将公务员的数量减少了30%，让医疗部门成了唯一一个实现关键成本节约目标的部门。

One official recalled: “He could be quite forceful but he tended to employ a more intelligent approach, asking: ‘Why haven’t you thought of this?’ rather than shouting at you – which in some ways was more difficult to deal with.”

一位官员回忆道：“他可能相当强势，但他往往会用比较聪明的方法，他会问，‘你们为什么没有想到这点？’，而不是对你大喊大叫。从某种程度来说，这种方式叫人更难应付。”

Mr Stevens will have to navigate tricky internal politics. His own background will cause some trouble. He knows that some will – inaccurately, he insists – portray him as an instinctive “privatiser” as a consequence of his time at UnitedHealth. He has already demonstrated a deft touch in choosing to forgo 10 per cent of his ￡211,000 salary “in the light of NHS spending pressures”.

斯蒂芬斯将必须驾驭棘手的内部政治。他本人的背景会带来一些麻烦。他知道，由于他在联合健康集团供职的经历，有些人会把他说成是天生的“私有化者”——这是不准确的，他坚称。“鉴于NHS的开支压力”，他选择了放弃其21.1万英镑年薪的10%，此举已显示出了他娴熟的管理风格。

Changes to the role mean his writ will not run as far as that of his predecessors. The majority of the health budget is now in the hands of groups of clinicians, which means that he will have direct control of only 30 per cent of the sum spent on the English part of the service each year. The coalition’s reforms have removed operational control of the NHS from Jeremy Hunt, the health secretary, but insiders say that he continues to intervene, particularly when he thinks there is political capital to be made.

职责的调整意味着他的权限将不及他的前任们。如今大部分医疗预算由临床医师团体控制，这意味着他仅直接控制每年花在英国人身上的医疗服务支出总额的30%。英国联合政府的改革解除了卫生大臣杰里米·亨特(Jeremy Hunt)对NHS的运营控制权，但内部人士表示，他还是会干预，特别是在他认为可以从中捞取政治资本的情况下。

Mr Milburn says that if anyone can make this “chaotic and confused” architecture work, it is Mr Stevens. “I have never known a time when the NHS has been so lacking in certainty and clarity of direction,” he says. One of his main tasks will be to find ways to unlock innovation and enterprise in a system long characterised by command and control. Central diktat may have worked when the principal problem was waiting lists, but is less effective for improving the quality of care.

米尔本表示，如果有人能让这个“混乱、令人感到困惑”的体系运转起来，那就是斯蒂芬斯。他表示：“NHS从没有像现在这样缺乏确定和清晰的方向。”他的主要任务之一将是找到方法在一个长期以命令和控制为特点的体系中释放创新和进取精神。在主要问题是候诊名单时，中央指令可能会起作用，但这对于提高医疗质量却没那么有效。

If he can present a tighter spending environment not simply as a constraint but as an opportunity for much-needed changes in the way care is delivered, Mr Stevens could help recalibrate public expectations of the NHS and aid its survival as a free-to-all service well into its seventh decade. If he fails, and the service declines, he will attract much of the opprobrium from a frustrated public.

如果他不仅仅把紧缩的开支环境视为一种制约，而是视为一个机遇，对提供医疗服务的方式进行亟需的改革，他就能帮助改善公众对NHS的预期，帮助NHS作为全民免费服务体系存活下来，顺利踏进其第7个十年。如果他失败了，该体系衰落，那么失望的民众就会对他大加责难。

But the challenge of running the organisation in which he has spent most of his professional career seems to have been worth the risk. Mr Lilley added: “He said to me: ‘I’ve thought about it and I’m going to do it?.?.?.?You know how I feel about the NHS’.”

但管理NHS这个挑战似乎值得冒险，他的大部分职业生涯都是在这里度过的。利利补充称：“他对我说，‘我考虑过了，我要做这份工作……你知道我对NHS的感情’。”

The writer is the FT’s public policy editor