As you will be aware, in a headline announcement this morning, the Prime Minister announced that NHS England will be abolished and brought under “democratic control” in an attempt to cut bureaucracy and duplication.
The news of NHSE’s abolition comes a day after ICB leaders were informed that they would need to cut their running costs in half by December. NHSE had been planning to issue a new operating model in the next few weeks that would have clarified the roles of ICBs and trusts. This will now likely be revised.
Starmer’s speech preceded a statement by the Health Secretary Wes Streeting in the Commons. Please see below a short summary of the statement.
Background to reform
- Streeting discussed the rationale behind the changes, stating that Labour inherited an NHS which is going through the worst crisis in its history and a £200 billion black hole in public finances.
- He noted that the “urgency of the crisis meant they have to go further and faster to deliver better value for taxpayers and better services for patients”. Citing Lord Darzi’s review, Streeting said the top-down reorganisation of the NHS introduced by Lord Lansley had created a “complicated and fragmented web of bureaucracy”.
- He said that there were twice as many staff in the NHS now than in 2010, but that taxpayers are “paying more but getting less”. He also said there was an enormous amount of duplication within DHSC and NHSE and that “such bloated and inefficient bureaucracy cannot be justified”.
- He said that there is a duty on ministers to get the best value for taxpayers as possible, something which is “not achievable within the current set up”. He added that “frontline staff are drowning in the micro management to which they are subject”.
Details on reform
Impact and timescales of reorganisation
- Streeting said that the integration of NHSE within DHSC would “turn one team into one organisation”. He added that the changes were not a reflection on the staff but that they have been “set up to fail by a fragmented system that holds them back”.
- Streeting noted that “much change can be delivered without the need for primary legislation” but recognised that the government will need to make some primary legislative changes and are working to develop an appropriate timeline for this.
- When asked about timescales, Streeting confirmed work would begin immediately and integration would be complete in 2 years time.
- When asked about the reduction of officials, Streeting said he wants to reduce the overall headcount by 50% across DHSC and NHSE (noting that there are currently 15,300 staff in NHSE and 3,300 staff in DHSC).
The new structure
- Streeting commended Sir Jim Mackey as Interim CEO and said he is working with him to put in place a new transformation team alongside NHSE Chair Dame Penny Dash.
- The transformational team will be announced shortly, and will bring expertise from across the country and outside the NHS.
- He added that there would also be fresh clinical leadership and would appoint 2 national medical directors to follow the departure of Professor Stephen Powis (one for primary care and one for secondary care). Streeting assured members that there would not be unnecessary political interference in clinical leadership.
Role of NHSE in the transition
- He assured that work was already underway to “strip out duplication and bring many of NHSE’s functions into the department”.
- He stated that NHSE would have a clear function over the transition period, specifically re: holding local providers to account and making sure they are “better customers” to the medical technology innovators.
The benefits of reform
- Over the next 2 years, NHSE will be brought into the department entirely to deliver a “leaner team” and make savings of hundreds of millions a year, which “will flow down to the frontline”.
- Streeting argued that “ending the infantilization of NHS leaders”, the changes will “set local NHS providers free to innovate, develop more productive ways of working and deliver better care for patients”.
- He stressed the need for local decision-making to meet the needs of different communities, whilst strengthening the role of government in helping to deliver the same standard of care throughout the country.
- When asked about NHS procurement, Streeting acknowledged that procurement needs to reform as it is important to get value for money. He added that the “liberation of frontline leaders to focus on things that really matter” would support reform in this area.
Reactions to the announcement:
The Kings Fund broadly welcomed the move for democratically elected officials to have oversight of the NHS, and the attempt to remove duplication and waste, however they have called on the government to be clear why this structural change is necessary and how it fits into wider plans to improve productivity and patient outcomes.
NHS Confederation and NHS Providers released a joint statement that said they understood the dynamics at play but added that it comes at “an extremely difficult time”, calling for a balance between “recovery and reform”.