Matt Hancock announces shake-up giving ministers more power over NHS

Health secretary tells MPs Covid has strengthened case for change, but experts say power grab could backfire

Matt Hancock has formally unveiled plans for a significant reorganisation of the health service that he said would bring better integration and accountability and less bureaucracy, but which will also concentrate power over the NHS with ministers.

Saying the coronavirus crisis had emphasised the need for both a more holistic approach to population-wide health, and better integration with care services, the health secretary portrayed the plans for NHS England as implementing the desires of NHS staff, councils and others.

“We have listened, and these changes reflect what the health and care family have been asking for,” Hancock told the Commons, detailing plans for a healthcare white paper that will undo many of the changes made under the former Conservative health secretary Andrew Lansley.

But Labour immediately questioned both the timing of the changes and raised concerns about accountability of new integrated care organisations to local people. “Where does the buck stop?” asked Jonathan Ashworth, the shadow health secretary.

Saying the plans were the product of two years of discussions with the health service, local authorities and others, Hancock said they were intended to “make the system work for those who work in the system”.He told MPs: “At its heart, this white paper enables greater integration, reduces bureaucracy and supports the way that the NHS and social care work when they work at their best – together.

“It strengthens accountability to this house, and crucially it takes the lessons we have learned in this pandemic of how the system can rise to meet the huge challenges and frames a legislative basis to support that.”

While the process had begun before coronavirus, Hancock said, the pandemic had further demonstrated the need for change, both in better connecting health and social care, and also in population-wide preventative health measures.

Hancock set out the more top-down approach to leadership within the English health service: “Medical matters are matters for ministers. The white paper provides a statutory basis for unified national leadership of the NHS, merging three bodies that legally oversee the NHS into one, as NHS England.

“NHS England will have a clinical and day-to-day operational independence, but the secretary of state will be empowered to set direction for the NHS and intervene where necessary.”

Replying for Labour, Ashworth said that while he could see the need to undo some of the Lansley changes, it was the wrong moment for such wholesale reorganisation.

“We’re in the middle of the biggest public health crisis our NHS has ever faced, staff on the frontline are exhausted and underpaid. The Royal College of Nursing says the NHS is on its knees,” he said. “And the secretary of state thinks this is the right moment for a structural reorganisation of the NHS.”

Jeremy Hunt, the former health secretary who now chairs the Commons health committee, said he knew “how distracting it can be” to the NHS to make such changes.

“It is nonetheless the right thing to do, and a brave thing to do,” said Hunt, who began his speech by praising staff at his local hospital in Surrey who had treated him that morning after he slipped during a run and broke his arm.

However, Hunt said the public needed to know who was in charge in their local area, calling for Ofsted-style ratings for the new local integrated care bodies.

NHS bodies and health experts have warned ministers that the power grab could backfire, distract staff from caring for patients and lead to the government being blamed by the public for any setback or controversy in the service, such as unpopular plans to downgrade a local hospital.

source: Peter Walker

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