At the end of March, Amanda Pritchard, Chief Executive at NHSE, stood down from her post after almost four years in the role, during which time the NHS responded to the Omicron wave of COVID-19, published the inaugural NHS Long Term Workforce Plan and reduced the number of people working for the NHS by over one third, saving nearly £500m to reinvest in frontline care. Amanda Pritchard’s successor is Sir James Mackey, who has been given a remit to reshape how NHSE and the Department for Health and Social Care (DHSC) work together.
Sir Mackey was previously the Chief Executive of Newcastle Hospitals NHS Foundation Trust and National Director of Elective Recovery. He also has previous experience of national leadership within the NHS – notably during his previous tenure as Chief Executive of NHS Improvement. Commenting on the appointment, Wes Streeting, the Health and Social Care Secretary, said he was ‘delighted that Jim Mackey has agreed to step up to provide new leadership for a new era for the NHS… He knows the NHS inside out, can see how it needs to change, and will work with the speed and urgency we need.’
Along with a new Chief Executive, NHSE also welcomes a new Chair, Dr Penny Dash, who succeeds Richard Meddings. Dr Dash is no stranger to social care, having been asked in May 2024 by the DHSC to conduct a review into the operational effectiveness of the Care Quality Commission (CQC).
Dr Dash discovered significant failings in the CQC, finding a deterioration in the CQC’s ability to recognise poor performance and support quality improvement. Following the report, Dr Dash said, ‘Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care system which the general public deserves.’ About Dr Dash’s new appointment, Wes Streeting said, ‘She is a radical reformer, with the skills and experience we need to help fix our broken NHS and make it fit for the future.’
Dr Dash and Sir Mackey step into their new roles at a time when the NHS 10-Year Health Plan, which is part of the Government’s health mission to build a health service fit for the future, is being developed. One of the three shifts outlined in the plan is to move from delivering care in hospitals to delivering care closer to home, in communities and in primary care. Dr Dash has said of the plan, ‘The 10-Year Health Plan is a once-in-a-generation opportunity to shape the NHS to take on the challenges of the future and I look forward to playing my part.’
With a new Chief Executive, who will be examining how NHSE and the DHSC can work together more effectively, and a new Chair, who has explored in detail the regulatory challenges facing the sector, should those working in and drawing upon social care feel optimistic about the visibility, oversight and recognition of the sector becoming more comparable to that of NHSE? In addition, how will the recent announcement that NHSE will be brought back into the DHSC play its part? Initial sector responses to Government’s directive for integrated care boards (ICBs) to cut running costs by 50% have prompted concern that already unsustainably low fee rates paid by NHS commissioners risk worsening as a result of the restructuring.
Social care has often found itself in the slipstream of NHS reorganisation – in a career spanning five decades, I cannot think of one that has been free of at least one major shake-up. But once the dust has settled, other than new job titles and a different structure chart, things continue much as before. Will it be different this time? Few tears will be shed at the Government’s unexpected decision to abolish NHSE, described as the world’s biggest quango, and merge its work with the DHSC. There is a strong case for removing the duplication of work across the two bodies. It concludes the unravelling of the Lansley reforms in 2012, widely considered as disastrous. In theory, it should be easier to co-ordinate health and social care policy within a single organisation. But capacity and attention will be absorbed by a major internal redesign of roles and functions, distracting from bigger and arguably more important priorities – improving NHS performance, delivering the forthcoming NHS 10-Year Health Plan and ensuring sufficient organisational bandwidth to deliver social care reform. It creates great uncertainty in the short term, especially for many thousands of people whose jobs are affected. Of even greater significance for social care is the related decision to slash the running costs of ICBs by a whopping 50%. This will enfeeble the capacity of these pivotal partnership bodies, barely three years old, to offer much-needed system leadership in which social care is fully engaged. It will almost certainly presage the merger of many boards to cover much bigger geographical footprints. Oversight of the NHS is set to become even less local, disrupting the chemistry of working relationships on which effective joint work with social care depends. This time, things will not be the same. Richard Humphries, Senior Policy Advisor to the Health Foundation. X @RichardnotatKF Email: [email protected] The neighbours are being noisy again. What should we in social care make of the top-down shake-up of the NHS, by a Government that entered office last summer promising no more top-down shake-ups of the NHS? On the face of it, the abolition of NHSE and the transfer of its functions back into the DHSC may seem just a nasty domestic argument the other side of the party wall. Perhaps we should turn up the telly and mind our own business. But this is both a threat and an opportunity for social care: a threat because the shake-up puts at risk the 42 local integrated care systems (ICSs) responsible for a joined-up approach to health and wellbeing; and an opportunity because it may prove possible to put in place something better. Why a threat? ICBs, which oversee the ICSs network, have been told to cut their costs by 50%. Critics say this will leave them incapable of effective system leadership and they will inevitably cede power and initiative to local NHS trusts. At national level, these fears have been underscored by recruitment of a raft of hospital trust bosses to the transition body that will wind down NHSE. Looked at another way, though, the ICSs record has been patchy and disappointing and social care has often struggled to be heard. Could this be, as Care England has argued, a chance for a ‘new era’ of integration fostering development of truly innovative models of care at a neighbourhood or ‘place’ level where social care agencies might better engage? Much remains to be inked in by way of detail of the new NHS structure; much is probably still undecided ahead of the NHS 10-Year Health Plan. Never a better time to have the neighbours round for a drink. David Brindle, Chair, Ambient Support X @DavidJ_Brindle Email: [email protected]