All governments show off their virility by reorganising the NHS….again

One of the reasons why the NHS bodies with the longest history – hospitals – know that they only need to respond VERRRY slowly to NHS commissioners is because the next time they look those commissioners will be gone and replaced by another structure.

Here we go again

The government is:

• Abolishing the arms length body NHS England – subsuming some of its functions into the Department of Health and Social Care.
• Cutting the management budgets of the sub-regional Integrated Care Boards in half.

Some thoughts.

I have struggled to see the added value of NHSE. Many of its functions appear to have been either performance managing local NHS providers on behalf of the Government or allocating funds to local providers …. on behalf of government.

Generally speaking it appears to have struggled to bring a more independent voice that brings added value to Government Policy.

Having said this I think DHSC have benefitted from having NHSE because government has been able to say that it is NHSE who are responsible for allowing waiting times to grow and hospitals to over overspend. In theory this abolition will bring this accountability closer to Westminster. Unless there is someone else to blame of course.

Inequality

One of the areas that I am particularly worried about is health inequalities. I do think that Bola Owalabi’s team in NHSE has made significant strides in championing and embedding action on health inequalities in the wider NHS

I have concerns that the team will struggle if it is transferred into a Government department. My worry is that it will be at the mercy of a ministers in a way that was not the case at NHSE.

I cannot think where else this important function can go – the NHS Confederation maybe, the best option is possibly to be based with a ‘super ICB’ – see below.

Integrated Care Boards

As I flagged at the top Integrated Care Boards have until the end of 2025 to make cuts of 50% in their management costs. This is a real worry.

1. They are still very young organisations and frankly most members of the public and many local decision makers have no idea that they exist or know what they do. From some work that I did for the NHS Confederation I think that there are a number who have made a significant impact (for example West Yorkshire, North East London) these have a sophisticated understanding of their local health and care system and a plan to change them for the better. Alas, there are almost certainly more who have taken a safer and less impactful approach.
2. There is a distinction between ICB staff who are part of place teams (in South Yorkshire we have 4 place teams one each for Sheffield, Barnsley, Rotherham and Doncaster) and those staff who have a more corporate role. In my experience the place teams are crucial when it comes to influencing local providers about how they respond to population health challenges and utilise NHS funding. The most attractive model for me would be to merge ICB – so in Yorkshire and Humber have one not three. This would then permit place teams to be protected and (very) senior management to be reduced.
3. One of the biggest problems that the NHS has been wrestling with for years is how to change the role of hospitals – in particular getting them to take more responsibility for population health. There are examples such as Kings and Guys & St Thomas Foundation who have made real strides here. These changes could be used to increase the accountability that Hospitals have to Government and could lay the foundation for a wider population health approach led by Hospitals in partnership with primary care, local government and the VCS. A small but important example of this is the Pathways work which was initiated by University College Hospital. Under the leadership of Aidan Halligan they took action on issues outside the hospital – homelessness because it affected their services.

I am not holding my breath.

There are interesting points of view here:

BMJ by David Oliver: Abolishing NHS England is no panacea for the NHS’s woes

and here: Andrew Harrison: Are ICB cuts a bigger story than NHS England?

What do you think?