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NHS reorganisation is less a ministerial power-grab and more a Tory apology to NHS

26th Feb 2021
NHS reorganisation is less a ministerial power-grab and more a Tory apology to NHS

Secretary of State for Health and Social Care, Matt Hancock, addresses Parliament on February 9
(Credit: Jessica Taylor/UK Parliament)

Musa Naqvi

Earlier this month saw the leak of a 40-page draft White paper titled Integration and innovation: Working Together to Improve Health and Social Care for All, outlining Health Secretary Matt Hancock’s latest plans for new legislation to reorganise the NHS in England.

It is the first such detailed legislation in a decade, and it majorly changes the way health and social care is organised. Press commentators have largely-viewed these proposals as a ministerial power-grab; with some questioning the timing as the health system works to combat a national healthcare crisis.

The proposals do centralise control in ministerial hands, with greater direct intervention powers for the Health Secretary, when required with Foundation Trusts. On the social care front, the Government’s plans of bailing-out struggling private providers of social care is an example of centralisation of control and authority. It can also be seen as a reaction to the way Covid-19 has decimated the elderly care home market. Yet, given the chaos and a vacuum of accountability the past decentralisation created, coupled with the current national healthcare crisis, going-back to central coordination and control may not be a bad thing.

When in 2011 David Cameron’s then Health Secretary, Andrew Lansley, reorganised the NHS, it had seen the creation of an independent NHS England (NHSE). NHSE is an arms-length engine room to the Department of Health (DoH) run by technocrats, setting the direction of health policy, but decoupled from the whims of Westminster politics. Lansley had surrendered an element of control, and yet in the world of public perception, he still had the ultimate accountability for the NHS failures.

Lansley reforms had also seen the abolition of regional health bodies, with the creation of GP-led borough-wide Clinical Commissioning Groups in charge of organising and purchasing healthcare as well as greater competition and privatisation of healthcare. Indeed, each of the last two financial years saw over £9 billion of Department of Health spending on private healthcare firms.

The latest proposals unravel much of the previous decade’s policy reforms. They take away an element of control and independence back from the arm’s length NHSE and other quangos, a consequence of which is that ministers will now not only have greater power but will also have greater accountability to Parliament and the added burden of direct blame for any future policy failures.

The reforms also mean a return to back to organising healthcare at a regional level and a disbanding of the more decentralised Clinical Commissioning Groups. The new Integrated Care Systems (ICS) will cover 42 regions across England, each with a population base of around 1 m-3 m.

The logic being that through the sharing of data between health and social care bodies (hospitals, local councils, ambulance services, mental health, community services and the 3rd sector), the pooling of resources (workforce and others) as well as sharing of risks, regions will be able to deliver better outcomes for their populations.

For those working within the health services, ICS aren’t new or surprising construction. Integration has been the talk of the town for over a decade. Informal elements of integration between health and social care bodies, between Clinical Commissioning Groups and local councils, providers and purchasers of care have existed for several years. Normal NHS winter-planning rounds each year already bring together informal cooperation of the various stakeholders and more greatly so during the current pandemic. Yet, these latest reforms provide statutory footing to these organisations and place a legal duty to collaborate.

The ICS will have the power to eliminate the need for a continuous cycle of tendering, and procurement of healthcare contracts resulting in a decreased NHS reliance on the private healthcare market. It also means a reduced fragmentation, with more focus returning on the quality of care as opposed to feeding the continuous obsession with austerity and value for money

However, longer-term and more stable contracts do require an effective regime of monitoring and can expose the NHS to the risk of cronyism as well as failures of centralisation as typified by NHS Track and Trace and the Nightingale hospitals.

In this quest for integration between health and social care, there is one fundamental tension these reforms fail to resolve, we know that healthcare is delivered free at the point of need, and its organisation is given accountability through the Parliamentary process, yet, social care, where much of the Tory austerity is aimed at, is not free at the point of use, it is in fact means-tested with accountability on provision through local council elections.

It remains to be seen how the proposed reforms will resolve this conflict of incentives for integration to be effective, there is however one thing, which we can be sure of. This isn’t a Tory power grab at play, but rather a belatedly implicit apology for the last decade of the wrong done to the NHS and social care.

Musa Naqvi, Healthcare Manager, Children & Young people Learning Disabilities & Autism, Greater Manchester

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