On 13 March the Government announced it would be abolishing NHS England and rolling its functions into the Department of Health and Social Care (DHSC). The previous day ICB leaders had been told they needed to reduce their management budgets by half by October, meaning the funding for ICB staffing would fall by half. The DHSC has committed to funding ICB redundancies centrally.
The announcement took the form of a press release from the Government, before Rt Hon Wes Streeting MP, Secretary of State for Health and Social Care, gave a statement in the House of Commons.
Key points
- The Times reported Wes Streeting is looking to halve NHS England’s 15,000 headcount, halve the DHSC’s 3,000 and combine the remaining staff under the DHSC. Mr Streeting told the Commons that the NHS England and DHSC staff numbers have doubled since 2010.
- Legislation will be required to abolish NHS England which Mr Streeting is working on it with Lucy Powell, Leader of the House, but he expects to be able to do a lot of his reforms prior to that legislation passing. He told the Commons he wants it completed within two years.
- The HSJ reported on Jim Mackey asking ICBs to reduce their running costs by half, with a deadline of October. This follows a 20% cut to running costs that should have been implemented over the last two years. The HSJ predicts mergers of ICB functions, possibly full mergers of ICBs along regional mayoralty boundaries to retain capacity to deliver their obligations, but full mergers are less likely in London with its larger ICB populations.
Extracts from Wes Streeting’s statement to the commons
Most of the statement provided the rationale for abolition and over-arching narrative on the Government’s aims for the NHS, with little detail of how the abolition of NHSE and merger with DHSC would be implemented in practice. It’s notable that Streeting essentially ducked a question on what impact ICB cuts will have on delivery of the Government’s plans on prevention and moving care into the community.
Saving money:
“The budget for NHS staff and admin alone has soared to more than £2 billion. Taxpayers are paying more but getting less. We have been left with two large organisations doing the same role with an enormous amount of duplication.”
In response to Health Select Committee Chair, Layla Moran MP (Lib Dem, Oxford West and Abingdon) on whether ICB cuts will put place-based teams, the ‘neighbourhood NHS’ and the 10 Year Plan at risk:
“…the direction that “we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build.
Time frame:
“On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years.”
Lansley reforms:
“The Health and Social Care Act 2012 established more than 300 new NHS organisations, created a complex and fragmented web of bureaucracy and, to quote the Darzi investigation: “imprisoned more than a million NHS staff in a broken system”. Today, we are putting the final nail in the coffin of the Conservatives’ disastrous top-down reorganisation of the NHS.”
Reducing bureaucracy:
“I am sure Members will have heard their local NHS leaders complain about the top-down way in which the NHS is run. It is something I have heard for years. Now that I find myself at the peak of this enormous mountain of accountability, I do not just recognise the complaint; I agree with it. Frontline NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy.”
In response to a question on bureaucracy from Dr Simon Opher MP (Lab, Stroud) who is also a jobbing GP:
“I am grateful for the leadership that GPs have shown in agreeing a contract with the Government for the first time since the pandemic, which contains substantial reform to benefit them and, even more importantly, their patients… We have to liberate frontline staff and managers to help them be more effective, to manage their resources more efficiently and, most importantly, to deliver better and safer care.”