BMJ 2013;347:f5812 doi: 10.1136/bmj.f5812 (Published 1 October 2013)
Page 1 of 2
Observations
OBSERVATIONS BODY POLITIC
Does NHS England have a slow puncture? So much for decentralisation: England’s health secretary can’t keep his hands off the NHS Nigel Hawkes freelance journalist London
the health secretary of the obligation to provide a comprehensive and universal service. Compare that with Hunt’s interventions. On emergency care he was detailed and specific, even to the point of naming the trusts that would share the £250m (€300m; $400m) bung aimed at easing pressure this year and how much each should get.2 He made no mention of NHS England. He subsequently called for renegotiation of the GP contract, including the possibility of handing back responsibility for out of hours care,3 ensuring named clinicians for vulnerable elderly patients,4 and an expansion of GP numbers and funding.3 It hasn’t taken long for former health secretary Andrew Lansley’s plan for a “hands-off” NHS to hit the rocks. His successor, Jeremy Hunt, is behaving as if the Health and Social Care Act 2012, with its careful separation of powers, had never passed into law. If there’s a problem—and there are plenty—it isn’t long before Hunt comes up with a new wheeze for dealing with it, as health secretaries always have. From pressure on emergency care to hospital quality or the supposed iniquities of the general practitioner contract, he’s there with an opinion and an initiative. His junior minister, Dan Poulter, has echoed his master’s voice with a plan of his own, suggesting with no great originality that the NHS could save money by better procurement.1
The merits of these interventions matter less than their frequency and specificity, which tell us that the Lansley plan is in tatters. Liberating the NHS, the July 2010 white paper that set out the plan, said that the aim was to give the NHS greater freedoms and to prevent political micromanagement. The NHS Commissioning Board (now NHS England) would lead on the achievement of health outcomes, allocation of resources, quality improvement, and promoting patient involvement and choice. The Department of Health’s own NHS functions would be “radically reduced” and become more strategic, focusing on improving public health, tackling health inequalities, and reforming adult social care. The bill that resulted even stripped
With the party conference season upon us, there is nothing surprising about a senior minister trying to show he’s on top of his brief or throwing out initiatives that he can later sprinkle in his conference speech, golden threads among the fustian. But the purpose of the legislation was to limit this type of political displacement activity. Naive from the start, the idea that ministers responsible for a budget of more than £100bn could wash their hands of the way it was spent has failed to last until lunchtime.
The result leaves NHS England as a dead letter. It’s supposed to be responsible for quality, but it was Hunt who decreed that hospitals should have ratings similar to Ofsted’s system to rate schools and a chief inspector of hospitals.5 And it was Hunt who announced the “buddying” scheme to help failing trusts.6 It’s supposed to allocate resources, but it was Hunt who announced where the extra money for emergency departments was to go. The directors of NHS England must wonder what they are supposed to be doing. The organisation’s recent annual general meeting provided few clues. It was an odd affair, held at 6 pm at the tail end of a series of workshops whose participants reported back with the usual mixture of wishfulness and imprecision familiar to anybody who has ever attended an NHS workshop. The chairman, Malcolm Grant, showed every sign of having gone native, greeting these unexciting recapitulations as if they were the tablets of Moses. “It’s time to have the courage to take on the really big challenges,” said one participant as Grant nodded
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BMJ 2013;347:f5812 doi: 10.1136/bmj.f5812 (Published 1 October 2013)
Page 2 of 2
OBSERVATIONS
sagely. “The NHS belongs to the people,” said another. More sage nods. My notes understandably tail off at this point, but the session can be viewed in its entirety on the NHS England website. It’s had 31 views.
NHS England has shed board members disconcertingly, including the deputy chief executive, Ian Dalton (who joined BT), Jim Easton, national director for transformation (who joined the private provider Care UK), Mike Richards (who became chief inspector of hospitals at the Care Quality Commission), and, most importantly, David Nicholson, the chief executive, who is still in post but has said he’ll retire at the end of March next year.7 It’s hard to escape the feeling that NHS England has a slow puncture. At the AGM only two board members, Bruce Keogh and Tim Kelsey, conveyed much conviction.
Chris Hopson, head of the Foundation Trust Network, told the BBC recently that the Department of Health and NHS England were at war. He said, “Sometimes those of us in the NHS look up and think, ‘This is warring parents who ought to get their act together so we can do what we need to do in the NHS.’” His claims were dismissed as “unsubstantiated opinion” by the health department, which claimed a close working relationship with NHS England. If, despite these denials, we suspect that Hunt is impatient with NHS England, the same can also be said of London’s mayor, Boris Johnson. He’s shown little confidence in NHS England’s local area teams by calling in Ruth Carnall, the former head of
For personal use only: See rights and reprints http://www.bmj.com/permissions
NHS London, to advise him, and the former Labour health minister Ara Darzi to head a new London health commission. Meanwhile NHS England has appointed Clare Gerada, former chairwoman of the Royal College of General Practitioners, to lead a review of primary care in London. The capital won’t be short of advice.
If it’s to make a mark, NHS England will need to be quicker on its feet, more adept at public relations, and generally cannier. A lot hangs on the appointment of Nicholson’s successor. Choosing an outsider with a bit of charisma wouldn’t hurt. Competing interests: None declared. Commissioning and peer review: Commissioned; not peer reviewed. 1 2 3 4 5 6 7
Torjesen I. Better procurement can save the NHS in England £1.5bn over three years, says report. BMJ 2013;347:f4951. Kmietowicz K. Doctors condemn Hunt’s plan to link emergency department funding to staff flu vaccination rates. BMJ 2013;347:f5639. Iacobucci G. GP contracts should be simplified to allow more “professional discretion,” says England’s health secretary. BMJ 2013;347:f5633. Torjesen I. Health secretary’s remarks about GPs are “morale sapping,” says royal college. BMJ 2013;347:f5545. Dyer C. Government responds to Stafford inquiry with new “whistleblower in chief” to rate hospitals. BMJ 2013;346:f2030. Wise J. “Super managers” to be sent into failing hospitals. BMJ 2013;347:f5727. Hawkes N. Nicholson to step down as chief executive of NHS England. BMJ 2013;346:f3364.
Cite this as: BMJ 2013;347:f5812 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
Observations
OBSERVATIONS BODY POLITIC
Does NHS England have a slow puncture? So much for decentralisation: England’s health secretary can’t keep his hands off the NHS Nigel Hawkes freelance journalist London
the health secretary of the obligation to provide a comprehensive and universal service. Compare that with Hunt’s interventions. On emergency care he was detailed and specific, even to the point of naming the trusts that would share the £250m (€300m; $400m) bung aimed at easing pressure this year and how much each should get.2 He made no mention of NHS England. He subsequently called for renegotiation of the GP contract, including the possibility of handing back responsibility for out of hours care,3 ensuring named clinicians for vulnerable elderly patients,4 and an expansion of GP numbers and funding.3 It hasn’t taken long for former health secretary Andrew Lansley’s plan for a “hands-off” NHS to hit the rocks. His successor, Jeremy Hunt, is behaving as if the Health and Social Care Act 2012, with its careful separation of powers, had never passed into law. If there’s a problem—and there are plenty—it isn’t long before Hunt comes up with a new wheeze for dealing with it, as health secretaries always have. From pressure on emergency care to hospital quality or the supposed iniquities of the general practitioner contract, he’s there with an opinion and an initiative. His junior minister, Dan Poulter, has echoed his master’s voice with a plan of his own, suggesting with no great originality that the NHS could save money by better procurement.1
The merits of these interventions matter less than their frequency and specificity, which tell us that the Lansley plan is in tatters. Liberating the NHS, the July 2010 white paper that set out the plan, said that the aim was to give the NHS greater freedoms and to prevent political micromanagement. The NHS Commissioning Board (now NHS England) would lead on the achievement of health outcomes, allocation of resources, quality improvement, and promoting patient involvement and choice. The Department of Health’s own NHS functions would be “radically reduced” and become more strategic, focusing on improving public health, tackling health inequalities, and reforming adult social care. The bill that resulted even stripped
With the party conference season upon us, there is nothing surprising about a senior minister trying to show he’s on top of his brief or throwing out initiatives that he can later sprinkle in his conference speech, golden threads among the fustian. But the purpose of the legislation was to limit this type of political displacement activity. Naive from the start, the idea that ministers responsible for a budget of more than £100bn could wash their hands of the way it was spent has failed to last until lunchtime.
The result leaves NHS England as a dead letter. It’s supposed to be responsible for quality, but it was Hunt who decreed that hospitals should have ratings similar to Ofsted’s system to rate schools and a chief inspector of hospitals.5 And it was Hunt who announced the “buddying” scheme to help failing trusts.6 It’s supposed to allocate resources, but it was Hunt who announced where the extra money for emergency departments was to go. The directors of NHS England must wonder what they are supposed to be doing. The organisation’s recent annual general meeting provided few clues. It was an odd affair, held at 6 pm at the tail end of a series of workshops whose participants reported back with the usual mixture of wishfulness and imprecision familiar to anybody who has ever attended an NHS workshop. The chairman, Malcolm Grant, showed every sign of having gone native, greeting these unexciting recapitulations as if they were the tablets of Moses. “It’s time to have the courage to take on the really big challenges,” said one participant as Grant nodded
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f5812 doi: 10.1136/bmj.f5812 (Published 1 October 2013)
Page 2 of 2
OBSERVATIONS
sagely. “The NHS belongs to the people,” said another. More sage nods. My notes understandably tail off at this point, but the session can be viewed in its entirety on the NHS England website. It’s had 31 views.
NHS England has shed board members disconcertingly, including the deputy chief executive, Ian Dalton (who joined BT), Jim Easton, national director for transformation (who joined the private provider Care UK), Mike Richards (who became chief inspector of hospitals at the Care Quality Commission), and, most importantly, David Nicholson, the chief executive, who is still in post but has said he’ll retire at the end of March next year.7 It’s hard to escape the feeling that NHS England has a slow puncture. At the AGM only two board members, Bruce Keogh and Tim Kelsey, conveyed much conviction.
Chris Hopson, head of the Foundation Trust Network, told the BBC recently that the Department of Health and NHS England were at war. He said, “Sometimes those of us in the NHS look up and think, ‘This is warring parents who ought to get their act together so we can do what we need to do in the NHS.’” His claims were dismissed as “unsubstantiated opinion” by the health department, which claimed a close working relationship with NHS England. If, despite these denials, we suspect that Hunt is impatient with NHS England, the same can also be said of London’s mayor, Boris Johnson. He’s shown little confidence in NHS England’s local area teams by calling in Ruth Carnall, the former head of
For personal use only: See rights and reprints http://www.bmj.com/permissions
NHS London, to advise him, and the former Labour health minister Ara Darzi to head a new London health commission. Meanwhile NHS England has appointed Clare Gerada, former chairwoman of the Royal College of General Practitioners, to lead a review of primary care in London. The capital won’t be short of advice.
If it’s to make a mark, NHS England will need to be quicker on its feet, more adept at public relations, and generally cannier. A lot hangs on the appointment of Nicholson’s successor. Choosing an outsider with a bit of charisma wouldn’t hurt. Competing interests: None declared. Commissioning and peer review: Commissioned; not peer reviewed. 1 2 3 4 5 6 7
Torjesen I. Better procurement can save the NHS in England £1.5bn over three years, says report. BMJ 2013;347:f4951. Kmietowicz K. Doctors condemn Hunt’s plan to link emergency department funding to staff flu vaccination rates. BMJ 2013;347:f5639. Iacobucci G. GP contracts should be simplified to allow more “professional discretion,” says England’s health secretary. BMJ 2013;347:f5633. Torjesen I. Health secretary’s remarks about GPs are “morale sapping,” says royal college. BMJ 2013;347:f5545. Dyer C. Government responds to Stafford inquiry with new “whistleblower in chief” to rate hospitals. BMJ 2013;346:f2030. Wise J. “Super managers” to be sent into failing hospitals. BMJ 2013;347:f5727. Hawkes N. Nicholson to step down as chief executive of NHS England. BMJ 2013;346:f3364.
Cite this as: BMJ 2013;347:f5812 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
