It is only eight years since David Cameron’s Conservative-led government embarked on the colossally wasteful and destructive reorganisation set out in Andrew Lansley’s Health and Social Care Act 2012. Since then Simon Stevens, the boss of NHS England, has put substantial energy into trying to undo some of the damage, by quietly reversing or working around the most unhelpful changes. Boris Johnson won last year’s election with a raft of promises aimed at voters who see health as a top priority: 50,000 more nurses, 40 new hospitals, 50m additional GP appointments. That he is now reported to be embarking on a power grab should disturb everyone who cares about the health service’s effective operation. It also offers further proof that his administration’s modus operandi is to bully its way to centralisation.
The rationale for the taskforce set up to curtail NHS independence is that ministers are entitled to more control than they currently have over Mr Stevens. While annual investment in the service will have increased by £20bn by 2023-24, deficits and waiting lists are growing, leading to political frustration. At the same time, pressure is building over the government’s poor handling of the coronavirus outbreak. On Wednesday, Mr Johnson promised that there would be an independent inquiry, as called for by the Guardian last week, after it was revealed that Sir Keir Starmer had met representatives of a new group, Covid-19 Bereaved Families for Justice UK.
There is a case to be made for a new law to tidy up the messier corners of the post-Lansley landscape. A proposal to do this is supported by many health policy experts, and was until recently backed by ministers. But it now appears that rather than face up to their own failings over recent months, and partly because they were irritated that Mr Stevens did not offer more support, Mr Johnson and his health secretary, Matt Hancock, are bent on misdirection. The mess that has been made of testing, tracing and quarantine rules, the problems with personal protective equipment, the neglect of care homes: rather than dwell on any of these, the public will be encouraged to believe that the NHS requires structural adjustments.
Nothing could be further from the truth. Even when done well, system changes are draining and disruptive. The recent record of reorganisation is nothing short of disastrous. Instead of fixating on who is boss, ministers should aim to reduce demand. Moving fast on a national plan to cut obesity (thought to be one reason for the UK’s high Covid-19 death rate) would be one way of doing this. Another would be to use the size of their majority to forge a consensus on social care funding. A third would be to come up with a strategy for staff retention and recruitment. It’s not too late for the prime minister to change course. If he doesn’t, the public may conclude that power and reputation management concern him more than health.