Health Secretary Wes Streeting has said there must be a ‘new relationship’ between the Department of Health and Social Care (DHSC) and NHS England, following the resignation of chief executive of NHS England Amanda Pritchard.
In his acceptance letter to Ms Pritchard, he said: ‘We will also require a new relationship between the DHSC and NHS England, deepening the ‘one team’ culture you and I have started to build together since July.’
He added on X that there should be a ‘new era’ and that the next few months would be ‘pivotal moments on the road to NHS reform’, with former NHS Improvement CEO Sir Jim Mackey to take over as interim CEO.
Ms Pritchard in her resignation letter also hinted at the change being ‘radical’.
She said: ‘We have discussed for some time that radical reform of the size and functions of NHS England and the DHSC is needed to best support local NHS systems and providers to deliver for patients and drive the Government’s reform priorities, which you know I share.
‘Having put in place the foundations for a closer working relationship, I believe that the step change now required would be best served by new leadership in NHS England.
It is currently unclear what this ‘new relationship’ will look like. However, reports in the Guardian have suggested it will include the cutting thousands of NHS England jobs, merging some of its departments with DHSC, including their communications teams, and ending the ‘duplication’ of roles in some areas of health policy, such as primary care.
NHS England was originally set up in 2012 as part of former Conservative health secretary Andrew Lansley’s reforms which he said at the time aimed to ‘take the politics and politicians out of day-to-day management of the NHS’.
Known then as the NHS Commissioning Board, it was intended to be an independent body with executive powers and responsibilities.
However, NHS Confederation’s chief executive, Matthew Taylor, said this was ‘never realistic’.
He said: ‘The desire to take politics out of the NHS has merits, but we know from experience that this is never realistic. Politics requires politicians to react to the issues their voters care most deeply about, and the NHS is often one of the public’s top priorities.
‘The health secretary recognises there are pockets of duplication between the DHSC and NHS England, so it makes sense to explore how the two can work more effectively together. This is an opportunity to reset the respective roles and responsibilities of the DHSC and NHSE, with a clearer demarcation between policy and strategy setting that would be the department’s primary responsibility, with responsibility for operational delivery and implementation sitting with NHSE.’
He added that the system cannot be run entirely from Whitehall and that there should be more responsibility handed down to ICBs.
‘We believe that it continues to make sense to have a degree of operational independence and autonomy for the NHS,’ he said. ‘We would like to see that autonomy extend beyond NHSE, and we welcome the government’s intention to hand more responsibility to integrated care boards and provider trusts.’
‘As much as possible, we need to let local NHS leaders lead given they are closest to the needs of their communities, and that means reducing some of the needless micromanagement from the centre that can hold them back.’
Earlier this year, NHS England suggested that ‘most’ funding ringfences would be removed for 2025/26, with more freedom given to ICBs around what funding could be spent on.
