Is the NHS impossible to lead?
Researcher
Today it was announced that Amanda Pritchard would be stepping down from her role as Chief Executive of NHS England (NHSE). After a three-and-a-half year tenure, which involved seeing the NHS through the end of the Covid-19 pandemic, and working with five different Secretaries of State (four Conservative and one Labour), Mrs Pritchard stated that “now is the right time” for her to stand down.
This move comes shortly after some particularly damning criticisms of the leadership of the NHS. The Public Accounts Committee said that NHSE leadership “displays a remarkable complacency” and that “senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital”. And the moment is indeed vital. The departure of Mrs Pritchard also comes just ahead of the release of the 10 Year Plan — the Government’s (hopefully) bold and comprehensive strategy to “fix the foundations” of the NHS.
With Mrs Pritchard leaving, it did not take long for conclave to finish and the white smoke to issue from the crenulated chimneys of NHS England. Sir James Mackey, the chief executive of the Newcastle upon Tyne hospitals NHS trust, has been called upon to succeed as interim chief executive. But will a new leader really change anything?
At Re:State, we have long argued that you can't successfully run a health system of the size of the NHS, for a population this diverse, from Whitehall. In our paper last year, we argued that overly centralised healthcare system is impeding the transition to a more preventative model of care which is tailored to local population need. We suggested that NHS England should be abolished and that DHSC should take a more strategic role under the direction of the Secretary of State, reasserting stronger democratic accountability.
Rumours of reorganisation are now rampant. The Health Service Journal reports that the Secretary of State, Wes Streeting, wants to effectively move the role of NHS chief executive into his department, as it was before the 2012 Lansley reforms which created the vast quango of NHSE.
Mr Streeting should not stop there. We believe that changes should be made to devolve health commissioning and decision making to a level where strategic decisions can be made around a place. This would mean putting local government - more specifically, regional government - in the driving seat, with increased powers so that services can be tailor-made to meet local population needs. Looking to Greater Manchester, where health devolution of various kinds has been explored for years, would be a good start.
And we also should not stop with NHSE. At Re:State, coming soon in our Reimagining Whitehall programme is a report on the proliferation and purpose of such ‘arms-length’ public bodies — and the clear case that many of them are not fit for purpose.
As Amanda Pritchard bows out, we should ask: how have we ended up with a health system that is all but impossible to lead? Fixing the health system in England is a fiendishly difficult challenge: an Everest, not a Snowdon. But there is also an opportunity here for tenacious reforms that will make a lasting difference for the public.