The Week, 26 November

26 November 2021
By William Mills
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The Health Secretary's acceptance of the Wade-Gery review's recommendations cap a significant week for NHS reform. 

The review into the digital apparatus of the health system concludes that the status quo "remains too far away from" a 21st century health system. As a result, on Tuesday, Sajid Javid set in motion the merger of NHS Digital, largely responsible for IT and data services, and NHSX, tasked with digital transformation, into NHS England (spot the difference?).

Breaking the barriers between three separate organisations seeking the same objective is laudable — though cynics might, rightly, ask why the situation came to fruition in the first place — but the real question is how does this latest reorganisation help achieve better outcomes? Beyond the few successes listed by Wade-Gery, such as enabling 111 to directly book GP appoints to keep people out of A&E, many of NHS Digital and NHSX's objectives, such as increasing data-driven decision making and increasing interoperability across the NHS remain aspirations. This begs the question, what have the thousands of staff in these functions been doing, and will giving them different stationary help them deliver the "digitally enabled health system" we all want to see?

Part of the push to improve the digital infrastructure of the NHS is to support the Government's efforts to push forward it's Health and Care Bill, which will see the creation of 42 Integrated Care Systems (ICSs). The ICS proposal has, this week, prompted accusations of privatisation by stealth from MPs and unions. Private providers, many of which deliver services from ophthalmology through to mental health, will rightly be able to sit on new partnership boards under the proposals, but are unlikely to be part of NHS-dominated Integrated Care Boards, responsible for commissioning most health services.

The legislation will, in fact, make it harder to award contracts to non-NHS providers with no requirement for ICSs to put contracts out to tender. With much debate centred on this (wilful?) misunderstanding, Isabel Hardman made a very sensible observation: "when so much political energy is regularly expended on something that isn’t actually happening, the real mistakes in flawed legislation tend to pass into law without anyone noticing."

Finally, the expertise of the civil service was the subject of a punchy intervention by Kate Bingham, the Prime Minister's former vaccine tsar, in a Times Thunderer. Fear of failure, a lack of scientific expertise and a "culture of groupthink and risk aversion that stifles initiative and encourages foot-dragging" are among the charges Bingham levies. Though not new concerns, the repeated warnings, including our own, about the State's pandemic performance are concerning. With Civil Service reform seemingly having slipped from the Government's priorites of late, hopefully Bingham's intervention will have grabbed Ministers' attention.