The Department of Health: an overview of its quangos
Health and adult care services are surely complex matters but the challenges facing the 2,000 Department of Health HQ staff should be relatively simple: persuading HM Treasury to provide more resource and splitting that between NHS England (treatment and cure), adult care services and the technical quangos which address central issues such as the efficacy of medicines. The more that goes to the Department itself, and its quangos, the less goes to front-line services.
Remarkably, none of the 27 quangos focus specifically on adult care services or mental health – the two big problems of our time. NICE provides guidance on medicines, medical technology and, since 2013, social care. The Care Quality Commission (CQC) and the National Data Guardian monitor both NHS and adult care provision. The Health and Social Care Information Centre is now called NHS Digital as, according to its 2016/7 annual report, it now aligns itself with the NHS rather than social care. None of the other 23 gives address social care at all. The DH should, perhaps, have an over-arching public body, equivalent to NHS England, to oversee adult public services, especially since the front line services are largely devolved to local authorities.
As discussed in an earlier ASI Blog[1], NHS England, now an “Executive Non-departmental Public Body”, should become a publicly owned corporation, if only to stop politicians and civil servants messing it up. Remarkably, the DH has eight quangos interfering, or helping depending on one’s point of view, in NHS England’s business: Independent Reconfiguration Panel, National Information Board, NHS Business Services Authority, NHS Digital, NHS Improvement, NHS Litigation Authority and the two review boards for NHS staff pay and doctors/dentists. Clearly decisions for staff differ from GPs who are independent contractors for the context is the same and the board needs to be fair across both sectors.
Five of those can be seen as services that NHS England would itself need, one way or another. The Independent Reconfiguration Panel, National Information Board and NHS Improvement, however, exist purely to tell the CEO of NHS England how to do his job in addition to the stream of instructions from the DH itself. The three should be disbanded.
Six other quangos clearly need to be independent from the NHS: Administration of Radioactive Substances Advisory Committee, CQC, Human Fertilisation and Embryology Authority, Human Tissue Authority, National Data Guardian and the NHS Blood and Transplant. The CQC and Data Guardian monitor performance and patient confidentiality respectively. The other four are technical/scientific.
Of the remaining 12 quangos, five should be disbanded and seven have overlapping functions and could be merged into three quangos. Merger does not of itself guarantee better value for money but at least it gives the opportunity for squeezing costs to prioritise what matters most. The seven could therefore be merged into two agencies: Public Health, and Medicines and Technology (NICE). The public health agencies are Public Health England, Health Education England and the Health Research Authority. The other four are National Institute for Health and Care Excellence (NICE), British Pharmacopoeia Commission, Commission on Human Medicines, Medicines and Healthcare Products Regulatory Agency.
The existing NICE is far the largest of this last group, with 600+ staff and a budget of £65M p.a. Its guidance on medicines can be controversial but is unquestionably independent and well informed. The 2013 tacking on of adult social care seems culturally alien and receives relatively little attention. Much of its social care guidance can be parodied as “all the involved people should be involved”. This responsibility should be transferred to the new adult social services public body proposed above.
The final proposed disposals are the Accelerated Access Review, Advisory Committee on Clinical Excellence Awards, Committee on Mutagenicity of Chemicals in Food, Consumer Products and the Environment, Morecambe Bay Investigation and Porton Biopharma Limited. The first and fourth of those completed their work some years back and should no longer be listed. Deciding, once a year, which consultants should receive awards does not need a full time DH quango, just an ad hoc committee of the NHS. The Mutagenicity Committee is actually three separate ones which belong in their separate Whitehall departments – the Food Standards Agency for food, BIS for consumer products and DEFRA for the environment.
Porton Biopharma Limited is either the profitable commercial enterprise, as the DH website claims, in which case it should be privatized, or that is a cover for high security research, in which case it should become part of the Ministry of Defence.
Although the idea of “taxpayer value” has now been espoused in Whitehall, comparing the taxpayer value of, say, a destroyer with an acute hospital is somewhat with an acute hospital is somewhat conjectural. This overview of the DH quangos has indicated that, excluding the NHS and Adult Care bodies, only about nine of them are necessary. Divvying the annual budget 12 (NHS and Adult Care England, nine quangos and the DH itself) ways, once a year, and writing a few policy and briefing papers, is not a lot of work: all bar 200 of the HQ staff could safely be stood down and thereby fund another 1,800 doctors and nurses.
The “bonfire of the quangos” promised (again) in 2010 was more of a puff of smoke. Some were merged but most were unaffected. The streamlining of quangos outlined in this overview is not so much to save money as to give the NHS a better chance of improving its performance. No NHS England chief executive needs this many quangos looking over his shoulder and telling him how to do his job.