Abolishing NHS England won’t solve anything
4 min read
NHS England should not continue in its current form. But Wes Streeting's 'moving deck chairs' abolition won't work.
The abolition of NHS England was not a surprise. When the incoming Labour government said they – not NHS England – would prepare and publish the 10-year plan for the NHS, the implication was only too clear. Nor am I surprised that Labour want to repoliticise the NHS, as a wedge issue they traditionally use against the Conservatives.
But is it the wrong policy? NHS England had grown to be a department outside of the department – far beyond what was originally envisaged. It was obvious that over time ministers would want many of these regulatory or legislative functions back. The duplication between the NHSE and the department is the result of NHSE being allowed to ignore the ‘Lansley reforms’ and the Health and Social Care Act 2012.
The NHS Commissioning Board for England was turned into NHS England, which centralised many functions in their own hands. Instead of competition between providers driving up standards, NHS England created an unresponsive monopoly; instead of encouraging new providers to offer services, NHS England actively shut them out; managerial targets instead of accountability for outcomes.
The lesson of implementing the 2012 reforms is that only to have done one part – creating NHS England (going beyond, in its name and functions, the NHS Commissioning Board conceived in the 2012 Act) – and then allowing it not to implement the other parts (such as clinically-led local commissioning; competition and choice; choice of large-scale commissioning support organisations; tariff reform; ‘any qualified provider’; and a mandate annually from the government and Parliament to the NHS with accountability through the NHS Outcomes Framework) led to a centralised, bureaucratic system that failed to achieve the potential for improvements in outcomes.
Now Labour ministers look doomed to repeat the mistake.
There is no difference in centralising control in a department of state as compared to a national arm’s-length body – save the fact that decisions will now be taken by ministers for political rather than clinical or managerial reasons. There will be no transparency about which decisions are made politically. In practice, politicised needs will reach deep into operational decisions.
The ‘Lansley reforms’ were about outcomes. The White Paper was about holding the NHS accountable for improving outcomes, and giving the NHS the autonomy it needed to take responsibility for redesigning services around value-based healthcare. We reduced the total health running costs by £1.5bn, and when I left the department the waiting list was 2.64m – the long waits I inherited virtually eliminated.
Now the obsession with ‘control’ goes on. Wes Streeting says he wants “democratic control”. That was always available, through the mandate to the NHS, agreement to the 10-year plan, budgets, directions and emergency powers as needed. All transparent – whereas now all that will disappear.
Control is the obsession of self-serving bureaucracies. Improving outcomes is the driving force of a clinically-led health service. I know which I prefer.
Centralising everything in DHSC is a strategic error. The NHS will hand every problem back to the department. We will see NHSE functions being recreated in Integrated Care Boards all across the country. No doubt also a large new DHSC regional structure and the disruption of a major top-down reorganisation of the NHS (sound familiar?).
Or is ‘democratic control’ cover for breaking up the NHS and handing it over to mayors? How big a cuckoo in their nests!
I do not believe we should keep NHS England. We should go back to the principle of autonomy and accountability. The NHS should own the operational decisions for improving outcomes for patients and be accountable to ministers for meeting their mandated priorities and objectives. This isn’t a quango state; it is a practical division of responsibilities, and ministers should refocus on improving public health and social care.
The driving force in the NHS should be improving outcomes for patients, achieved through evidence-based, clinically-led commissioning pathways, and access to choice and competition amongst providers based on quality. Those were the driving motivations of the 2012 Act. No one should confuse that with this ‘moving deck-chairs’ abolition of NHS England.
Lord Lansley is a Conservative peer and former health secretary.
