‘World’s largest quango scrapped’ – that was how the Government sought to spin today’s surprise news that NHS England would be rolled up, with 10,000 redundancies and a massive centralisation of power.
Coupled with integrated care boards being forced to halve in size, it’s a change which will upend how and who clients working in the healthcare space engage with in the months and years to come.
Despite a steady drip feed of senior departures in recent weeks, the PM’s announcement has taken NHSE staff, DHSC, and even the lobby by surprise. There is genuine shock among staff in NHS England at the scale of this announcement. To add insult to injury it landed on the day waiting lists fell for the fifth consecutive month, and while they were busy digesting the yearly staff survey.
What may have been badged as a bonfire of the quangos today has instead unveiled a much bolder mission. Solving the problem which has dogged Tory ministers and civil servants for over a decade. How to control the UK’s most costly public service?
The abolition of NHSE comes after years of Whitehall frustration and suspicion that NHSE was operating its own agenda – a feeling which reached its height under Simon Stevens’ tenure. Wes Streeting was right to say former Tory Ministers will be hugely envious, with Jeremy Hunt already coming out as an early supporter.
Overall the commentariat are supportive and in the long-term the change may prove politically savvy. We may see finally integrated, data and evidence led policymaking. But any machinery of government changes are long, bruising and will have talent casualties along the way.
If Reeves is seeing this as a precursor to wider savings plans, she may be disappointed. Previous headcount reductions in DHSC saw costs go up over the long term, rather than down, as redundancy payouts and rehiring spiralled in subsequent years. As a two year programme, and with no redundancy package agreed with HMT, the short term impact will be painful.
In the coming months NHSE and DHSC will inevitably turn inwards, with staff more worried about their own futures than bringing down waiting lists – let alone enacting reforms through the 10 Year Plan. External engagement will be challenging. The department risks losing expertise within policy teams which are not duplicative and operate exclusively within DHSC or NHSE.
A huge cultural shift will also be required within the department. Brexit, the pandemic, and even the merger with parts of PHE, showed up the limited operational and delivery experience in the department. It’s been over 10 years since DHSC had any operational functions, and shifting to oversee the myriad NHS structures across regions, ICSs, Trusts and providers will place unprecedented demand, and also power, upon the department. Abolishing NHSE will require primary legislation to unpick Lansley’s 2012 Act, and even parts of the 2022 Health and Care Act. Although this is anticipated in the next Kings Speech and will likely sail through, it will take time.
Downing Street does though benefit from the knowledge of NHSE veterans within its ranks, most notably Nin Pandit, Simon Stevens’ former head of office, now Starmer’s PPS – along with James Lyons, NHSE’s former Director of Communications.
The PM and Health Secretary have shown their commitment to cutting costs. But greater control will bring greater accountability. This is a calculated risk, but the public has rarely differentiated between the NHS and government when it comes to NHS waiting times. Control is a price worth paying if it can deliver results.
Time will tell if it pays off before the next election.
Max Blain, Partner and former Head of News at DHSC
Alex Donaldson, Director and former Chief Press Officer at DHSC
Sophie Eltringham, Director and former Deputy Director at DHSC
