On 13 March the government began a major shake-up of the NHS, abolishing NHS England (NHSE). Although that was welcomed, medical professionals and trade unions have warned against repeating the mistakes of the past.
Disastrous
The role of NHS England was inextricably tied up with the disastrous 2012 Lansley reforms which sought to entrench an “internal market” within the service. The result was fragmentation and chaos, only held back in many places by those working in the service.
But the health secretary, Wes Streeting, speaking to parliament on the same day focused on cutting costs – as well as closing NHSE, he halved funding for integrated care boards (one of the ways the NHS tried to mitigate the impact of the 2012 reforms).
No new model
Inevitably there will be job losses, but as yet there is no sign of developing a new model of a fully integrated, planned model that the NHS needs. NHSE was the custodian of the ten year plan for the NHS. It has limitations, but is at least a start. And the fate of workforce planning – essential, but neglected in the rush to recruit from overseas – is also unknown.
‘A fear of repeating past mistakes.’
Trade unions and professional bodies were critical of the 2012 reforms. They are not critical of the decision to abolish NHSE, but fear a repeat of past mistakes. The Royal College of Emergency Medicine and others are concerned that the latest restructuring will detract from patient care.
Prime Minister Keir Starmer made the initial announcement in a speech about reforming the role of the state earlier on 13 March. He claimed that NHSE was an example of duplicated bureaucracy and that transfer of control to central government would restore “democratic control”. He
Concern
The way that the announcement was made also causes concern. Government policy appeared to change daily, and showed a lack of regard for those displaced by closing NHSE and the loss of expertise.
Soon after taking office, Streeting asked eminent surgeon Ara Darzi to review the performance of the health system. He reported speedily that the NHS was in trouble and set out in detail his thoughts on how that came about and what needs to be done.
“…the costly and distracting process of almost constant reorganisation.”
Notably, Darzi pointed to the “costly and distracting process of almost constant reorganisation of the “headquarters” and “regulatory” functions of the NHS, but that its preset condition was not primarily a failure of management.
Starmer and Streeting seemed to have missed that point, and to have ignored Darzi’s view that some of the recent changes like integrated care boards “had the makings of a sensible management structure”.