As the dust settles after last weeks announcement, Paul Fisher examines the impact the merger of NHSE with DHSC will have.
Its fair to say we all sensed the Health Secretaries frustration with NHSE. The resignation of CEO Amanda Pritchard and other senior leaders was also a threat indicator of significant change. But no one expected the nuclear announcement of “the world’s largest QANGO” being merged with DHSC within two years. Coupled with the announcement that ICB’s must reduce operating costs by 50% by the end of this year, the health landscape is very different from seven days ago. What might this mean, and where are the threats and opportunities?
Action or reaction?
Part of the answer lies in the build-up. Was this a well-planned move which the government kept remarkably secret? Or was it a relatively recent decision caused by lack of confidence, a desire to gain political “grip”, or other factors? In my view – and that of the rather better-qualified former Health Minister Steve Brine – it’s the latter.
Centralising policy and decision-making within one department makes perfect sense. Having it under direct political control makes it easier for the government to drive meaningful change. And savings estimated at £500m per year are not to be sniffed at.
However, with 13,000 staff now understandably concerned about their future and significant structural change being made at a time when delivery is paramount, there will be significant ripples felt across the health sector. The ICB funding news makes it very likely that smaller ICBs will have to merge – assuming they are not the next casualty of the bonfire of the QANGOs – throwing more change into the system.
Devolved, not absolved
With the power now sitting with Wes Streeting, he is well-equipped to drive the seismic changes required to reform the NHS, starting with the Ten Year Plan. But the reverse of that medal is accountability – no longer can the government use NHSE’s autonomy as a shield.
With the responsibility for delivery now squarely with the Health Secretary, the next five years will likely dictate whether he is seen as a reforming moderniser and Prime Minister-elect or the latest Health Minister to find the NHS oil tanker too big to turn around.
Threats and opportunities
So what next for the diagnostics sector? Well, there is no greater proof of Streeting’s commitment to action than abolishing NHSE. And with diagnostics crucial enablers for the NHS’s “three shifts”, there is reason for optimism.
BIVDA’s key advocacy into NHSE has been around market access, better value assessment for IVDs, and a genuinely supportive environment for innovation. With an engaged and accountable political leader, (eventually) a single forum to feed into, the removal of duplication, and potentially more money for front line services, advocacy should be more effective.
ICB cuts are likely to result in local health authorities operating more regionally and at the strategic level. Strategic health authorities, if you will. Done well, this may result in better purchasing decisions with fewer points of contact for industry – offsetting the prima facie loss of the UK’s biggest purchaser.
However, the level of change and impact on staff cannot be ignored. Understandably, NHSE staff will have at least one eye on their own future. The ripples from Streeting’s decision will muddy the waters in the immediate future, possibly longer. The old saying “don’t make change in a crisis” doesn’t really work for the NHS, who are perpetually in a state of emergency, but the sentiment remains.
A new normal
In closing, the short-term instability as the new system is developed, implemented and matures is likely to have an impact on the system’s ability to absorb advocacy. But done well, the potential benefits will outweigh these. BIVDA has excellent relationships with the UK government, including DHSC, and are well equipped to mitigate the short-term challenges and leverage the new system will ultimately offer.
Interested in discussing this further? Our next Government Affairs Working Party will be discussing the topic in more detail. Please register here.
