Medical experts question wisdom of NHS shake-up during pandemic

Medical leaders and experts have questioned the wisdom of a big shake-up of the UK’s NHS which will hand more power to ministers as the health service strives to cope with the pressures of the pandemic.

They broadly welcomed a move away from competition in the NHS, but regretted the failure to give more detail of long-promised social care funding reform.

Unveiling a white paper in the House of Commons on Thursday, Matt Hancock, health secretary, said the proposals reflected changes that the health service had been asking for, adding that the response to coronavirus had accelerated the pace of collaboration across health and social care.

Under the plan, the NHS and local government would come together to plan health and care services jointly on the ground — something already happening in many areas but without clear legal authority. 

One of the potentially most far-reaching proposals would curtail some of the freedom that NHS England was granted in the 2012 Health and Social Care Act.

Hancock said the service would still have “clinical and day-to-day independence” but the secretary of state would be “empowered to set the direction for the NHS and intervene where necessary”. This would include earlier involvement in situations which might lead to hospitals being closed or downgraded.

Jennifer Dixon, chief executive of the Health Foundation, a charity, said one half of the proposals — to help local services collaborate better — “could help improve care for patients and follows the direction NHS leaders are already taking”. However, the other half, giving the secretary of state more power over the NHS, was “concerning, has no clear rationale and could take healthcare backwards,” she warned.

Nigel Edwards, chief executive of the Nuffield Trust, a think-tank, said ministers “may come to regret all the new powers they are set to be granted . . . The health service is so huge that decisions at the centre can easily miss the reality at the front line”.

As earlier governments had learnt to their peril, “centralising power means you centralise blame, and create more pressure to interfere”, he said, questioning where accountability for major decisions would now lie. 

The document points to a sharp downgrading in the role of competition in the NHS — the expansion of which was one of the most controversial elements of the previous big reform of the service a decade ago.

It promises to introduce “changes to both competition law as it was applied to the NHS in the Health and Social Care Act 2012 and the system of procurement applied to the NHS by that legislation”. 

David Hare, chief executive of the Independent Healthcare Providers Network, an industry body, said “patients and taxpayers alike” would want assurances that the NHS would have access “to the best and most innovative services regardless of who provides them, and that poorly performing services will be challenged to improve, including through the option of alternative provision”.

Others warned of attempting to introduce big changes when the service was still coping with the pressures caused by the pandemic.

Richard Murray, chief executive of the King’s Fund, a think-tank, said the NHS was “littered with reform plans that overestimated benefits and underestimated disruption”.

The white paper promises an announcement on social care reform later this year but Murray said the need was “urgent”.

Chris Hopson, chief executive of NHS Providers, which represents health leaders across the NHS, said the proposals “provide an important opportunity to speed up the move to integrate health and care at a local level, replace competition with collaboration and reform an unnecessarily rigid NHS approach to procurement”.

But he expressed concern about how quickly the changes, due to be introduced from 2022, could be implemented “given the operational pressures the NHS is currently facing”.