LOCALLY, our experience of NHS bureaucracy has not been particularly happy.
Then it was hand-to-hand combat with the Strategic Health Authority a few years later when – amazingly – they were looking at closing the Royal Surrey.
Every time there was a sense of a rather unaccountable NHS body doing things ‘to’ us against our wishes.
Some of you may even remember me sleeping rough in Parliament Square with the-then Guildford MP Anne Milton to draw attention to our campaign.
Throughout that period there were constant ‘reorganisations’ which seemed to make the NHS bureaucracy even remoter.
Then – shortly before I became health secretary – the coalition government fell into the same trap. I then spent six years trying to work around the reforms which, although well intentioned, were hugely disruptive.
Why, then, does Matt Hancock want to do the same thing? It is surely a perfect example of what Sir Humphrey from Yes Minister would call ‘brave’.
The three biggest challenges facing the NHS are workforce shortages, a struggling social care system and persistent issues with safety and quality, the latter highlighted by the worrying Ockenden review into baby deaths in Shrewsbury and Telford.
The new shake-up does not solve any of these issues. Some people are asking – reasonably enough – if it is therefore the right time for such an upheaval, not least with NHS staff so exhausted by a pandemic that has lasted far longer than anyone expected.
But curiously this obscure-looking change should actually help address all three of those big NHS challenges.
Last year was the first in history where there are more over-65s than under-fives.
But NHS staff feel incredibly frustrated they cannot deliver more joined-up care to the growing numbers of older, more vulnerable patients who often have more than one thing that has gone wrong at the same time.
If the new integrated care systems mean better links between hospitals, GPs and community care, staff will feel more motivated because they can do a better job looking after patients – particularly if they can deliver more preventative care that keeps people out of hospital in the first place.
Social care reform is long overdue and this Bill does not give the social care system a ten-year plan as the NHS has. Nor does implementation stop families living with dementia losing their savings or provide a penny of extra cash.
But the new structures – unlike the CCGs – will sit along local authority boundaries and make it much easier for the NHS and social care systems to merge.
Local authorities will have a seat on their boards, so things like single electronic health and care records will be much easier to set up.
This will make a big difference to patients currently having to repeat their story to every new clinical team they see.
But it is on driving forward recent progress on the safety and quality of care that these reforms will really be judged.
I introduced Ofsted-rating of hospitals and other NHS organisations to stop another Mid Staffs and change the culture of an NHS dominated by targets.
By the time I left, three million more patients were being treated in good or outstanding hospitals. But how will patients know if their new local NHS system, supposed to be joining up hospitals, GPs and community care, is doing a good job?
With such a lot of taxpayers’ money at stake, it is essential the CQC is enabled to give the new statutory bodies independent quality ratings just as it now does for hospitals.
NHS restructurings rarely work out as intended, as I know from my own experience. We must avoid at all costs the jobs merry-go-round that happened last time, with managers accepting huge redundancy payments only to be re-employed a few months later.
An NHS restructuring is indeed a brave thing to do. But there is a good reason to be brave right now: if we are to turn 2021 into a new ‘1948 moment’ for the NHS, as significant for its future as the year it was founded, then it is the right way forward because you have to start by making the plumbing underneath the world’s fifth-largest organisation fit for purpose.
In that context it will need to be accompanied by proper workforce reform to boost staffing levels and a long-term plan for social care if it is to be as big a change as Matt Hancock hopes.