Abolishing NHS England: Why Patient Care Must Remain the Focus
The last few weeks have seen the first stages of the new Health Bill passing through the House and much debate around what will happen after NHS England is abolished. As colleagues have written about, reorganising the NHS has been a semi-regular feature as national bodies have been “created, split asunder and then crashed together”. But why and to what end?
When the previous Secretary of State for Health and Social Care, Wes Streeting, announced the abolition of NHS England, it was billed as a way of reducing bureaucracy in a “bloated and inefficient” system. Savings to be made and be redirected into frontline services. A similar rationale was presented in 2010 when then Health Secretary Andrew Lansley created a new NHS Commissioning Board (later to become NHS England) to cut out waste, reduce bureaucracy and simplify NHS structures.
Regardless of motivations, what we can’t lose sight of in the debate is how this restructure and new Health Bill is going to impact patient care. There are several risks to changing this structure that could impact how patients experience and access their care. Firstly, in abolishing NHS England a lot of the decisions and operations are going to brought directly back into the Department of Health and with the Secretary of State. This risks centralised bottlenecks in decision making and slow down responsiveness in a complex system that does need some level of local responsiveness.
Secondly, structural change can be really disruptive and in having NHS leadership working out what the future looks like, can divert capacity away from service delivery. This can also create uncertainty for staff delivering those services for patients as well as for management. With staff satisfaction in the NHS low already, we know that this is associated with worse quality of care and higher levels of staff turnover. Creating more uncertainty could have a detrimental impact on patient care.
Finally, because the Bill itself is quite limited in detail, there are limits to what can be scrutinised as the Bill passes through the legislative process. Lots of the provisions being described are going to be set out in further guidance and regulations rather than in the Bill itself. But this means that, at this stage, no-one can know exactly how these changes to how the NHS operates will play out. If no-one knows exactly how it will operate, we can’t appropriately test and question the proposals to find out how it will impact patient care.
Linked to the abolition of NHS England and moving certain powers back to the Department itself, is the reconfiguration of Integrated Care Boards (ICBs). Certain powers that currently sit with NHS England will now be taken by ICBs and ICBs will now become directly accountable to the Department rather than NHS England. The Bill is also expected to mandate that statutory mayors (or a nominated deputy) be members of ICBs and also that ICBs carry out more strategic planning that closer align with priorities set out in the 10 Year Health Plan.
ICBs do need to be independent enough to respond to their own local population needs and develop long-term strategies based on those needs. However, they also need to be aligned with the national priorities and held accountable centrally. ICBs have recently been told to slash their operating costs cut by 50%; to also be asking them to take on new roles and responsibilities is going to be tough.
Sarah Woolnough is the Chief Executive of The King’s Fund, an independent charity working to improve people’s health
