NHS shake finds Boris Johnson ready to ditch ideology – POLITICO

LONDON The coronavirus pandemic is far from over and England’s National Health Service is not out of the woods yet, but its next big reform has already been initiated.

The obvious question asked by some exhausted health workers on the front lines is: why now?

It’s the second time in a decade that the British government has ordered a reorganization of the NHS and the latest plan gives a clue as to how Boris Johnson’s Tory party is going.

The latest round of reforms, led by then-Health Secretary Andrew Lansley in 2012, proved deeply controversial. They had ideas firmly rooted in Thatcherite orthodoxy in their hearts. Competition of the private sector with public health services is an inherent good, and the central government should be isolated from public services on the ground.

The new proposals put forward by current Health Secretary Matt Hancock in a government white paper represent a major about-face. They are removing the legal requirement for competitive health services in the NHS and placing much more power in the lap of the health secretary himself.

This is a sign that the Johnson government is less ideologically driven than many of its Tory predecessors and much more opportunistic. Despite being founded by the Labor Party on principles contrary to Johnson’s pro-market tendencies, the Prime Minister has made the publicly funded, point-of-use, free NHS a central part of his political identity.

Much of what is in the white paper has been proposed by key NHS England officials and has been in the works for some time. Lansley’s previous reforms saw the creation of clinical commissioning groups led by general practitioners, which received public funds and were tasked with purchasing health care services for a local area from the NHS or from private providers. The reforms were “never really understood” except by Lansley himself, said Nigel Edwards, chief executive of the Nuffield Trust think tank. They were never greeted warmly by Lansley’s Tory successors or the NHS.

Politicians and the NHS go on cycles of falling in love with different types of mechanisms, ”Edwards said. There has been a disenchantment with quasi-market mechanisms as a really major lever for change.

The new integrated health care systems which will henceforth be responsible for financing health care are already operational in some regions of the country.

That Johnson is ready to embrace the changes crafted by NHS leaders and casually brush aside pro-market thinking inherited from his Tory predecessor David Cameron is characteristic of a PM who sees himself in the tradition of Tory democracy . He’s pro-market, but relaxed about state intervention where it seems to work and (most importantly) is popular. And there are few areas of public life in which UK governments could gain or lose as much popularity as in their management of the NHS.

Eyes on 2024

But why now, in the midst of a pandemic? The answer, said Richard Sloggett, founder of think tank Future Health and former Hancock adviser, lies in the challenges ahead for the NHS and the Tories’ desire to address them in time for their public assessment in the 2024 general election. .

The government wants to get there now so that it is in place by April 2022. With the next election in 2024, that gives you a few years for these reforms to start to materialize, Sloggett said. The great thing they are going to have to offer is reduced wait times. We have hundreds of thousands of people waiting for treatment for more than a year after the significant disruption caused by COVID.

It remains to be seen exactly how or if the new structures can deliver. But Sloggett said the key reform to watch would be the additional powers acquired by the health secretary; an aspect of the overhaul that was not based on pre-existing NHS plans and that surprised many observers. While the NHS England governing body will retain its day-to-day clinical and operational independence, Hancock said reforms would allow him to define the direction of the NHS and intervene when necessary.

In other words, Hancock wants to be able to pull a lever in Whitehall and for the NHS to react on the pitch. With a rapidly growing treatment wait list that could become a major election issue in three years, you can see why he might want this.

But Edwards said he was optimistic that the reforms could have an effect by the 2024 election, and stressed that a chronic shortage of manpower in the NHS was the real problem with the service of health to solve.

What they will find is you can pull the levers as much as you want, if there are no orthopedic surgeons it doesn’t really matter, Edwards said. There’s a flawed theory on what the problems are that one way or another performance is a management problem or a lack of willpower; when in fact the real problem is not enough staff.

There is another risk for Hancock and Johnson contained in the reforms.

If the government wants to gain more control over the health service, Labor has the option to focus more on the performance of the health service and try to tie that more closely to Tory ministers, Sloggett said.

In the 2019 election, despite a series of NHS performance issues to highlight, Labor put more emphasis on claims that the post-Brexit UK-US trade deal would see parts of the health service sold to private US health care; the kind of political attack that was normal when the Lansley reforms were introduced.

Now they could now change their tactics a bit, Sloggett said.

So while more ministerial oversight might (in theory) help reduce those bloated waiting lists, as Hancock hopes, the risk is that the reforms will not deliver the push he hopes. And if the problems persist long after the pandemic is over, the blame will undoubtedly end with it.