In his eight months as UK well being secretary Wes Streeting has set out low-key reforms to the well being service, similar to new hospital league tables and firing underperforming managers, as a part of a vow to repair the “damaged” NHS.
On Tuesday, after Amanda Pritchard stated she was quitting as chief govt of the physique that runs the well being service in England, he unveiled a extra dramatic a part of his imaginative and prescient for the federal government’s much-touted “plan for change”: tighter Whitehall management.
“We are going to . . . require a brand new relationship between the Division of Well being and Social Care and NHS England,” Streeting stated. Pritchard’s successor, Sir James Mackey, had “a remit to radically reshape” ties, NHS England added.
Senior well being sector figures had anticipated Pritchard to exit, however not earlier than Streeting revealed his 10-year plan within the spring. They stated the promise of a brand new relationship mirrored the federal government desirous to look critical about NHS reform within the absence of an in depth technique.
“They’ve eliminated Amanda as a result of they wish to appear like they’re doing one thing,” stated one particular person, who has suggested the federal government. “It’s turn out to be apparent to everybody within the business that Wes’s crew got here in with out a plan.”
“It’s about optics,” stated one other well being sector determine, “and Wes needs to be seen as being extra radical.”
Final 12 months the federal government introduced a £22.6bn rise within the day-to-day finances of the NHS over two years and a £3.1bn enhance in its capital finances — hailing the most important real-terms development in day-to-day spending since 2010, outdoors the pandemic.
Hospital bosses welcomed the billions of kilos of latest funding however stated they’d solely preserve the NHS standing nonetheless, and the commitments appeared to fly within the face of Streeting’s repeated insistence that additional money can be conditional on reforms.
Allies of Streeting, who was shadow well being secretary between 2021 and final July, have defended the time he has taken to attract up a plan, pointing to the scale and complexity of the NHS and the pressures of an ageing and rising inhabitants with extra advanced well being wants.
Streeting has set out three “huge shifts” that will transfer the NHS from an “analogue” to a “digital” service, extra care from hospitals to communities and the service’s focus from “illness to prevention”.
However fellow cupboard ministers have raced to make their mark extra visibly: deputy prime minister Angela Rayner has, for instance, launched sweeping reforms to planning and the devolution system.
One well being sector determine stated: “A number of reforms would contain huge arguments with unions and if he has an eye fixed on management of the Labour celebration, is he prepared to make these huge strikes?”
Pritchard’s resignation coming someday after she met Streeting instructed he had been pushing for her departure, one well being official instructed.
Streeting informed reporters on Tuesday that he had not requested Pritchard to step down, however solely final month two parliamentary committees referred to as her management into query, describing her as “complacent” and “out of concepts”.
One authorities official stated Pritchard “selected to resign and it was all very amicable”, noting that ministers had been clear since final summer time that they “need a nearer working relationship between NHSE and DHSC”.
Streeting’s reform agenda would inevitably imply the 2 organisations shrinking, the particular person added.
Mackey — who’s chief govt of Newcastle Hospitals NHS Basis Belief and has held varied well being service roles — is anticipated to be in publish for a number of years, overseeing a far-ranging restructuring and discount within the variety of well being officers.
Richard Sloggett, who was a particular adviser to then Conservative well being secretary Matt Hancock and now runs a well being consultancy, stated Mackey had “finished the binding on in all probability a very powerful agenda” by slicing ready instances for non-urgent remedy after turning into nationwide director of elective restoration in 2021.
In that position Mackey had additionally pointed to how the federal government and NHS England might higher work collectively, devising a plan for lowering backlogs that positioned “Jim because the operational lead, however very a lot appointed by ministers”, Sloggett stated.
One other healthcare govt who has labored with Mackey stated he can be “way more pragmatic and way more results-oriented” than Pritchard.
A technique through which this is able to be evident was in a unique perspective to the personal sector, he predicted, including: “Amanda by no means actually both understood or favored, however tolerated, the personal sector, whereas Jim sees them as a part of the answer.”
This month Streeting introduced Penny Sprint, a former hospital physician and companion at McKinsey, as the brand new chair of NHS England from March. He additionally introduced in Tom Kibasi, chair of a number of NHS trusts, to draft the 10-year plan — a transfer that well being officers interpreted as them being sidelined.
Sarah Woolnough, chief govt of The King’s Fund, a well being and social care think-tank, stated Mackey was taking the helm “at an especially important time for the NHS”, with ministers attributable to set out huge adjustments and the service grappling with excessive demand and finances pressures.
“It’s essential that the 2 organisations [the health department and NHS England] proceed to work effectively collectively however equally necessary that NHS leaders retain operational and scientific independence for the day-to-day working of the service,” she added.
