From today’s Times:
Boris Johnson will use a new law to clip the wings of the NHS chief executive as he attempts to exert more control over the health service.
No 10 is concerned that Sir Simon Stevens, the head of NHS England, has too much power.
Dominic Cummings, the prime minister’s chief aide, believes that at present the law gives Sir Simon excessive freedom, making it hard for Downing Street to impose its will. There is also frustration in government about the slow pace at which the health service responds to demands from Whitehall. Legislation to be introduced this year will include powers for ministers to give orders to Sir Simon, who is meant to be operationally independent.
The government has begun monthly meetings with him and is demanding tangible reductions in waiting times after one of the worst winters on record for hospitals last year.
Mr Johnson is concerned that after winning an election by promising to support the health service, the government has limited control over it and needs “more levers to pull”.
The change will form part of a wider overhaul of NHS structures in which hospitals and GPs are subsumed into legally independent local care groups.
The plans have alarmed health chiefs, who fear the distraction of a reorganisation when they are struggling to stop waiting times lengthening.
Officials insist that despite tensions over control of the health service, Mr Johnson is not trying to start a war with Sir Simon, with whom he has been friendly since they studied together at Oxford University.
The Times understands that soon after the election Downing Street told the Department of Health to be “more assertive” with NHS England, a body set up under controversial 2012 reforms to take charge of the day-to-day running of the health service. The most contentious part of those reforms, designed by Andrew Lansley, who was then the health secretary, was the introduction of internal competition.
Sir Simon is trying to unwind this and has asked ministers to change the law requiring care to be put out to competitive tender.
Mr Johnson’s 80-seat majority has given ministers the confidence to go further and the Queen’s Speech promised “legislation that will accelerate the long-term plan”. In a government briefing seen by The Times, Matt Hancock, the health secretary, is told: “The proposals NHS England brought forward were designed in a different parliament than the one we have now, with an underlying principle to avoid an extensive reorganisation. As a result, while they would entail a shift away from the market model enshrined by the 2012 Act towards a much more managed system, they do not deliver the fundamental reform of the 2012 Act that we and the system believe will be needed.”
By next year Sir Simon wants all areas of the country to be part of an “integrated care system” that plans collectively, and the laws would make these voluntary forums legal bodies with budgetary powers.
Ministers plan to use the legislation to give themselves greater power to tell Sir Simon what to do. The briefing talks about “creating a power of direction for the secretary of state over NHS England”, telling Mr Hancock that it would ensure that the organisation was “appropriately accountable to the secretary of state for health and social care and parliament for all aspects of NHS performance, finance and care transformation and that you have sufficient levers to direct and influence [it]”.
Sir Simon recognises that with Mr Johnson so dominant there is little point in protesting. Despite an insistence that the relationship with No 10 is good, there is nervousness within the health service about what the changes will mean in practice.
Integrated care is widely supported by health experts, who believe that linking hospital, GP and social care is crucial to dealing with an ageing population. However, Chris Hopson, chief executive of NHS Providers, which represents health service trusts, said: “A key current principle is that trust boards are responsible for the care delivered by the trust. We blur that clarity at our peril . . . Given the complexity and risk involved in the delivery of frontline healthcare services, it’s vital that lines of accountability are clear.”
Downing Street and NHS England refused to comment.
Analysis
Internal NHS politics are about to collide with the Tory party (Chris Smyth writes).
The last time this happened was under Andrew Lansley’s 2012 reforms, which damaged the Tories’ credibility and were diluted at once.
Most in the NHS support Sir Simon Stevens’ vision for hospitals, GPs and others to work together, but the structures created by Lansley have made it harder to keep the elderly out of hospital.
In his ten-year plan, Sir Simon proposed changes to join up care. The Tory election win gives ministers the chance to go further and undo much more of the Lansley act.
Yet one key element of the Lansley act survives: NHS England, which made day-to-day running of the NHS the responsibility of an independent organisation at arms’ length from ministers. Sir Simon is too smooth a political operator for this to have led to many public stand-offs, but it makes No 10 unhappy that the most politically important public service does not obey its beck and call.
Boris Johnson knows that his long-term political survival depends on improving the health service. Yet NHS performance has been getting worse and while ministers take the blame, they can do little about it.
For Downing Street, taking advantage of an NHS bill to give themselves greater control is only logical.
Less clear is what the government wants to do differently. If Sir Simon cannot stop waiting lists getting longer, is Dominic Cummings likely to do any better?
East Devon Watch 