There was big news yesterday with Sir Kier Starmer’s surprise announcement of his plans to abolish NHS England. Although this was met with shock in the NHS England offices in Waterloo, it has been alluded to by Wes Streeting on a number of occasions, and foreshadowed by the movement in senior roles across the Department of Health and Social Care (DHSC) and at NHS England. The punchy delivery of the news of the plans to abolish the £200bn quango was fast and final - a bold solution to dealing with a bloated and unproductive public sector. It also supercharges changes we expected to see, ripping off the band-aid to create momentum and focus which drives quicker results in a renewed NHS. The hope being it will show progress ahead of the next election.
We’ve been reflecting on the potential benefits and challenges of this transition.
Benefits:
Reduced bureaucracy. It’s always been difficult to explain how the health service in England works, and we’ve watched a lot of animations that have tried to do this. Much has been said about the layers of management which have been slowing down decision making and spawning a huge bureaucracy as illustrated by the striking fact that there are twice as many staff working in NHS England and DHSC today than there were in 2010. Slimming down the workforce responsible for managing and directing the NHS should reduce duplication and layers of approval stifling innovation and action.
Less targets. As Jeremy Hunt said on the World at One yesterday NHS managers have more targets than any other healthcare system in the world. Reducing the number of targets and the need for endless reporting against these or moving to a system which simply leaves performance to local leadership could be the radical change the NHS needs.
More local autonomy. Less bureaucracy and targets should give rise to greater autonomy letting leaders create services and systems which respond to local need. To coin a cliché, the NHS has always had ‘pockets of innovation’ but how the system is inspired to innovate collectively has been a perennial problem. Releasing local leadership to get on and lead is a popular lever to grab onto. The change in how the NHS is run at the top of the office could be the right driver to hand over to local leaders.
Challenges:
NHS becomes paralysed by reorganisation which sidetracks delivery and innovation. Many commentators seem to see this as inevitable so it’ll be interesting to see how the new leadership team for the NHS keep the system focussed. At the same time proposed big job cuts and change, moving from one organisation to another will be stressful and complicated for individuals affected. A lot of recent attention has been on critical changes needed such as moving care from hospital to community - these changes can’t afford a two-year hiatus while the transition takes place.
The Secretary of State (SoS) becomes bogged down in NHS management. One of the drivers for NHSE at the get go was giving the NHS autonomy out of the political fray. The new highly competent leadership team under Penny Dash and Jim Mackey suggests there is a real intention to avoid the SoS getting bogged down in how the NHS runs. The appointment of the new permanent Secretary at DHSC will also support this. Emerging leadership structures will need to keep the SoS, Chair and CEO working their respective roles in a way which keeps the show on the road. Their working relationship will be critical in all of this – it was interesting to see that Wes focussed on this in his statement to Parliament yesterday.
What difference will this make to front line services and most importantly patient experience? The abolition of NHS England is big news in health sector circles but how does it make it easier to get an appointment with a GP? Many people watching the news yesterday were probably bemused by the end of NHS England thinking it was the end of the NHS itself. Time will tell how people will benefit from this change in management. Labour have asked they are measured by the experience people have getting an appointment or an operation so rapid re-organisation and minimal disruption is critical.
We have also been musing the future of ICBs. ICBs have been bruised from their previous 20% efficiency challenge which resulted in a reduction in staff and slimmed-down priorities. The next ask is for a further 50% cut in running costs. This is inevitably going to lead to mergers which we are already seeing via shared leadership roles across ICBs. So while the concept of integrated care is not going away, we expect to see less ICBs in total. Speedy reorganisation of governance will be critical to these organisations being able to effectively contribute alongside powerful partners such as provider collaboratives.
So, in short, never a dull day in the healthcare world! At ZPB, our mission is to help organisations understand and navigate the health system and how these changes impact and benefit partners, patients and society. If you have any questions or want to discuss these changes reach out, we’d love to chat.
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