By Ed McIntosh, Head of UK Practice Incisive Health
Eight months into the new Labour Government, this was the week in which the pre-election mantra of ‘Change’ finally, and quite abruptly, became a reality for the NHS in England.
The writing had been on the wall for NHS England’s future as an independent organisation, but the decision to take the path of maximal disruption in formally abolishing it has sent shockwaves through the health policy world.
Wes Streeting had long signalled his dissatisfaction with the organisational structures he inherited and his appetite for “radical” solutions - reform or die was the pre-election refrain - but there was also a sense that the government recognised that a full fat reorganisation could distract from its short-term goal of improving performance and the longer-term drive towards the ‘three shifts’.
Indeed, while the Darzi review did not hold back in its criticism of the 2012 Act that established NHS England, it also stated that a “top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”.
Streeting’s decision to move forward with major structural surgery will define his tenure as Health and Social Care Secretary – there are undoubtedly opportunities to drive more efficient working through a more streamlined national body and unlock savings that can be transferred to the frontline, but there are also significant political, operational and administrative risks.
Taking forward primary legislation on the NHS is inherently challenging – the parliamentary arithmetic means that there is no risk that Labour won’t be able to pass reforms, but the lengthy process of the passage of a Bill gives room for debates that Labour’s political opponents and internal critics will seek to use to cause headaches for the government.
It is also inevitable that the reorganisation will result in operational disruption that will shift focus away from performance, jeopardising the government’s already ambitious commitment to meet the 18-week target by the end of the Parliament - the simultaneous headcount reductions at the ICB level are also likely to cause focus to switch away from the front line in the short-term.
There is also a risk that the process of unravelling all of the many arms-length bodies that have been subsumed within NHS England’s umbrella over the years since the 2012 Act will demonstrate that there were some functions that it suited the Government to offshore to others – whether for operational reasons, such as safeguards around patient data, or to provide political distance, such as negotiating medicine prices. It is possible that the bonfire of the quangos will result in some fingers getting burnt.
In the longer-term, the decision to roll back the system to its pre-2012 structure may well prove to be beneficial to a future government that wants to be able to pull levers in Whitehall and see action on the ground. However, for a government that has staked so much of its political future on improving performance on the metrics that matter to patients, it is a bold gamble that it will be able to reap the rewards.