Our Coxless NHS
In June 2021, NHS England numbered 1.2 million staff. When Amanda Pritchard was appointed in August, was that number reporting to her? Wrong. In April 2022, it was just 9,794. Of course GPs are independent contractors and more than a million people work in the 240 acute, ambulance, community and mental health trusts and foundation trusts which are, nominally, independent.
The current Health Secretary, Steve Barclay, has 55% more NHS England staff (15,171) reporting to him than the CEO does. And all these 24,966 staff work for non-governmental public bodies which are, supposedly, independent of government and therefore reporting to neither the Health Secretary nor the CEO.
The present government is different because the Chancellor of the Exchequer, Jeremy Hunt, was Health Secretary from 2012 to 2018 and thereafter Chair of the Health and Social Care Select Committee. He is under the impression he knows more about steering NHS England than Pritchard or Barclay. Be that as it may, he has now appointed Patricia Hewitt, Labour Health Secretary from 2005 to 2007, to conduct an independent review of integrated care systems.
Does NHS England now have four coxes or none?
Her terms of reference came out on 6th December, and she should recommend, this month,
“how to empower local leaders to focus on improving outcomes for their populations, giving them greater control while making them more accountable for performance and spending
the scope and options for a significantly smaller number of national targets for which NHS ICBs [integrated care boards] should be both held accountable for and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the particular needs of communities
show the role of the Care Quality Commission (CQC) can be enhanced in system oversight”
Behind this lies, in essence, the bureaucrats long demand that the NHS should take over social care from local authorities. To muddy the water, the terms of reference lay down that local bureaucrats should have more control whilst simultaneously being more accountable and having to report “with a particular focus on real time data shared digitally with the Department of Health and Social Care.” It is not at all surprising that this job should have been given to a Labour ex-politician.
NHS England is already far too big and merging it with social services will help neither. Of course, they need to liaise but the way to do it is to have the NHS focus on treatment and cure leaving care to local authorities. Of the £1.2 million NHS England staff in June 2021, the people patients actually want to see, namely doctors and nurses, make up less than 40% of the headcount. Technicians and (some) managers are needed too but focus on its original role, rather than expanding it, would enhance value for money.
The experiments thus far with integrated care have not been analysed. The only good thing that has emerged so far from integrated care systems (ICS) is alignment of local authority/NHS local borders. That must help liaison. Shifting authority from the centre and middle management to the front line would also help, as it did with Covid. Pharmacies should be allowed licence on prescribing to relieve GP practices. These terms of reference are otherwise bound to increase costs and bureaucracy and, worse, distract over-worked GPs from treating their patients. GPs need less bureaucracy, form-filling and interference from NHS management and the DHSC, not more.
Instead, with no clue as to whether ICS improves matters, this NHS coxless four are steering straight for the rocks of worse service, greater costs, more deaths and longer waiting lists.