When Nye Bevan set up the NHS in 1948, he knew what his job as health secretary was going to be like. “Every mistake you make,” he told an audience of nurses, “I shall bleed for… all I shall be is a central receiver of complaints.”
Every single one of his successors has felt the truth of that prediction: even when they managed to separate the NHS off to be technically independent, ministers have always been the ones to answer for the performance and failings of the health service.
This week, Wes Streeting made sure there was nothing between him and all the complaints by abolishing NHS England and bringing the management of the health service right back in-house.
Announcing the change to MPs, Streeting claimed it was something the Conservatives had secretly wanted to do but never managed. That’s not quite right: the Tories were indeed the ones who made the NHS operationally independent from the Department of Health in their disastrous 2012 Health and Social Care Act. They then spent the ensuing decade regretting those reforms, which were dreamed up entirely in the head of then Conservative health secretary Andrew Lansley.
In 2022, they legislated to unpick the worst bits of the Lansley act, as it is colloquially known by everyone in the health world, but retained the operational independence of NHS England for the simple reason that most of them at the time thought this was the one sensible reform Lansley had introduced.
As it happens, that reform wasn’t Lansley’s idea anyway. It was something he was randomly tasked with making work in the space of a weekend when David Cameron, on a whim, asked him to develop a policy to make the NHS independent, like the Bank of England. The minister and his aides were dumbfounded: in what way was the health service comparable to the country’s central bank?
They never fully answered that underlying question, but at least came up with a solution to Cameron’s request, which was to set up what was initially going to be called the NHS Commissioning Board. This would run the NHS on a day-to-day basis, independent of politicians, who could only write a mandate every few years setting the direction of the service.
For a long time, even colleagues who regularly cursed Lansley seemed to think the independent bit was a good idea: it removed petty political interference. And it suited ministers to have someone else to blame when something went wrong: the receiver of complaints should be the chief executive of the service, rather than anyone who would have to answer questions in the House of Commons.
square ISABEL HARDMAN
Wes Streeting is quietly seizing control of the NHS from the hands of bureaucrats
Read MoreExcept it has never really worked that way, and nor should it. As Bevan foresaw, it will always be ministers who have to answer for the NHS performing badly. Besides, the idea of “taking the politics out” of public service delivery is an insult to the public, as it really means removing accountability from an elected government. Politics is the business of getting things done, but even politicians end up using it as byword for petty partisanship.
But Streeting’s reform won’t just be about politicians being more honest about who is in charge. There does have to be a benefit to ministers in such a big upheaval, otherwise they would, like the Tories, just try to muddle along with the way things are currently, cutting down on the duplication between teams in the NHS and the department, and making sure there was a pliable chief executive who would do as ministers wished.
The real prize here is not being able to receive complaints direct, but being in control. Even though Streeting again insisted this week that he wants to decentralise the NHS and ensure that there is greater local accountability, he also clashed with the outgoing leaders of the service, including Amanda Pritchard, over the idea that he, rather than those officials, should be the one more closely setting the direction and pushing for improvements.
One of the final nails in the coffin for NHS England was its inability to explain how it would meet its productivity targets, beyond Pritchard repeatedly saying she was confident of managing it. Ministers want to be able to probe that much more, and are not likely to end up leaving productivity gains to local leaders.
Many health service lifers have seen this film before, of a performance-focused management culture led by ministers: it was exactly what New Labour did when in office, too. Perhaps this time around, Streeting won’t follow some of the more controlling, unpleasant aspects of that culture, which bled down through the health service ranks in the form of fear of missing targets and bullying of staff by managers.
It is, though, very easy to set out saying that you just want to release the health system to perform better, and end up doing precisely the thing you’ve promised you won’t. After all, the Conservatives set up NHS England as an independent body having promised “no pointless top-down reorganisation of the NHS”.
It’s funny how often a government ends up doing precisely the thing it said it wouldn’t. But one thing this Government cannot avoid doing is improving the performance of the NHS. Otherwise, it will end up bleeding for that failure, just as Bevan predicted.
Read More Details
Finally We wish PressBee provided you with enough information of ( Abolishing NHS England gives Wes Streeting what he really wants: control )
Also on site :
- Jury begins deliberations in Mike Lindell defamation trial in Denver over election conspiracies
- Israeli strikes on Iran ‘completely unprovoked’ – Moscow
- Prince William Suffers Devastating Personal Loss