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Should a politician be in charge of a health service?

This week the UK government has laid out a new phase for its NHS and health minister Matt Hancock plans to give himself direct power over the health service. What could go wrong?

The jury is out on whether this is a sensible move. One source quips that we could end up in a position where the NHS is kicked like a political football between prime minister Boris Johnson’s mop and the leader of the opposition Keir Starmer’s quiff. “I feel like we’ve stepped back around 10 years and not necessarily learned from history. It’s quite an interesting kind of power grab. It doesn’t mean that it will act on that power but it’s made the whole system much more accountable.”

Long-term planning is the key issue. These new reforms overturn a system that local clinical commissioning groups (CCGs) have only just got used to, nearly ten years after the reforms were introduced. Many had to train themselves in population management and will now have those responsibilities taken away.

The workforce is exhausted, both from reorganisations and from the pandemic. Hancock insists that now is the right time because population health issues like obesity have exasperated the need for better-integrated care. But a system where any incoming minister can make continuous tweaks is going to further antagonise its staff. Management needs continuity.

On the other hand, we hear the government has been quietly fed up by how slowly parts of the NHS moved through the pandemic, and that greater accountability can only be a good thing.

“They had good intentions and tried to model it on the Bank of England. It only sets interest rates, it doesn’t do its own banking. Whereas the difference is that when you do operational controls to depoliticise the NHS it doesn’t really work. Simon Stevens (Chief Executive of the NHS) doesn’t report to cabinet, Simon Stevens doesn’t report to parliament. If he screws up then who is accountable?”

As for integrated health, attempts have often been stymied by a failure within the NHS to willing or able to buy IT platforms and services from groups such as Centene or Optum, which would enable the joining up of the dots.

So far integrated care has been left in the hands of family doctors who have been encouraged to use spreadsheets and contact local pharmacies and schools. This has been an amateur approach which has been embraced by a few enthusiastic DIYers but is unlikely to succeed long-term.

We would welcome your thoughts on this story. Email your views to Rachel Lewis or call 0207 183 3779.