Beware the Ides of March?

It was Oscar Wilde who once said ‘the optimist sees the doughnut, the pessimist sees the hole’. I guess whether you are a optimist or a pessimist might be reflected by the context, or a particular situation. That seemed to be the case last week. The NHS had its own ‘Trump moment’ as the Prime Minister announced that NHS England was to be absorbed by the Department of Health and Social Care (DHSC) over the next two years. It would do so with the loss of 9,500 jobs.

Now for many NHS people this will be devastating news, and for many NHS folk this decision will have come as a complete surprise. It came after the earlier news that Amanda Pritchard (NHS England Chief Executive) was stepping down and being replaced by Sir Jim Mackey. He has been described as a ‘transition Chief Executive’ and perhaps we can now see why.

Back in the second week of July 2024, I posted a blog which expressed my concerns about what would happen to the NHS under the newly elected government. For me, the writing was on the wall after reading that Wes Streeting (Secretary of State for Health and Social Care) had brought both Alan Milburn and Paul Corrigan in to help him tackle the issues facing the NHS. I also noted that despite promises of no restructuring of the NHS, I wasn’t convinced we wouldn’t see change. There have been nine changes of government since the NHS was created in 1948, and all have tried to reform and restructure the NHS. I think however that last week’s news takes restructuring to a new level.

Last week, all NHS Chairs and Chief Executives had to attend a meeting in London to hear some of the detail of the proposed changes. I duly went along. However, there wasn’t much in the way of detail. The questions asked often failed to be answered by anything other than headline responses. Some of these were, frankly, alarming. On top of the reductions at NHS England and DHSC, it was announced that the 42 Integrated Care Boards (ICBs) would need to reduce their costs by 50%. It seems likely that the only feasible way to do this will be by reducing staff numbers. There are some 25,000 people currently employed by these ICBs, so this could lead to a further 12,000 jobs being lost. Likewise, all NHS Trusts, will need to reduce their corporate back-end services (Finance, Human Resources, IT and so on) costs by 50% too.

I think both these ‘asks’ will not be easy to achieve, and if they are achieved, it is likely chaos will ensue and be extremely detrimental to effective organisational functioning. That, in turn, will lead to care being impacted, both from a quality and possibly a safety perspective. But perhaps I’m guilty of ‘only seeing the hole and not the doughnut’. I’m sure, however, that I’m not alone in being worried. What did surprise me was the number of folk, both those whom I spoke to in person last week and others commenting on social media, who are rejoicing at the passing of NHS England.

It surprised me because Amanda Pritchard (and Sir Simon Stevens before her) was a popular leader, but perhaps that was only felt by people outside of government. It’s true that NHS England could sometimes be stifling, controlling, very conservative and slow to act, but my personal experience has been one of support, consistent leadership and helpfulness. They were an effective countervailing force to some of the chaos we experienced from the previous government during the challenging times of the Covid pandemic. And for that reason alone, I will always be grateful they were there.

The catalyst for these changes were said to be unacceptable variations in productivity, and financial sustainability. We still haven’t got back to the levels of productivity seen before Covid. There are a number of good reasons why this might be. However, it was the fact that the first draft operational plans submitted this February showed a £6.7 billion gap between what the NHS had been allocated and what the services themselves felt they wanted/needed. The changes referenced above are expected to save at least £500 million a year. Sounds like a great deal of money, but it represents just 0.25% of the NHS budget, and I can’t see how it will fulfil the government’s promise of more money for the ‘frontline’.

Much more importantly, for me, at least, is the trauma, sense of betrayal and impact these changes will undoubtedly have on so many colleagues who have worked in the NHS for so many years. As a group, they also represent a great deal of experience, knowledge and skill. Letting this go will be difficult to replace in the future.

Finally, last week the Care Quality Commission (CQC) published its latest report on the use of the Mental Health Act. It makes for grim reading – see here. It’s abundantly clear that mental health services across the board, but particularly those supporting children and young people, need considerable investment. At the same time as Wes Streeting said there would be no major reforms for the NHS, he also pledged to prioritise mental health and children’s services. On this matter, I’m firmly an optimist, so I sincerely hope we see this promise being delivered.