Wes Streeting, Labour's health minister, whose remit only effectively extends to England, said last night that the NHS was full of brilliant people who were set up to fail.
He used this claim to justify the abolition of NHS England, which abolition will, no doubt, be incredibly costly. The costs of disruption will mean not a penny is likely to be saved during this parliament, I am sure. The legislation cannot even be passed for at least two years, apparently.
Importantly, there is no vision on health in this. All we have here is a management reorganisation at the very centre of the NHS as far as England is concerned. The impact will be as remote from the hospital corridors where the massive failure of this government is apparent. It is as if this government is continuing the plan that the NHS should fail.
My suggestion is that this is exactly what Streeting wants for the NHS. His plan for the NHS was hidden in plain sight in the words he used yesterday.
Streeting says his plan is to cut central admin and devolve responsibility. But, why is he so keen on that? I suggest that is because what this permits is privatisation. After all, why else has Streeting cleared out the leadership of NHS England? Could it be he had to do so to remove those who would stand up for a state NHS, when what Streeting, Starmer and Reeves want more than anything else is to sell it off?
In my opinion, nothing else can explain this decision to close NHS England.
The Tories are delighted at what Starmer and Streeting are doing. That's hardly surprising, but Streeting taunted them about it in the Commons yesterday, asking what role there was left for the Tories when Labour was shrinking the size of the state, reducing bureaucracy, investing in defence and cutting immigration?
My question is what is the role for Labour now that it is so very obviously what the Tory party was until very recently, but more so?
The obvious follow-up is, where in that case is the party that becomes Labour, as was?
Is there no ambition left?
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The alternative explanation is simple incompetence – and there’s nothing in Streeting’s background to suggest he has any real management ability – he has never run any kind of organisation for a significant length of time – but if you have no real ideas either you can be easily persuaded that another administrative restructure will give at least the appearance of doing something. Especially if you don’t understand that the persuaders you’re listening to have their own agenda.
So Streeting claimed yesterday that Labour has gone back on it’s “change” manifesto promise and now just copies Tory policy. At least he has admitted our democracy is broken.
NHS England was devised by Lansley (there was even a rap song about the imbecile and the NHS). It was never clear to me what NHS England was supposed to do – apart from tory politicos being able to say that health problems are down to NHS England (= towel, bowel, water soap).
LINO had +/- two years to “prepare for government”. It is clear from the bribes paid to LINO/Streeting/Starmer that privatisation is the only way forward, & not just for the NHS. The point blank refusal to do ANYTHING about the water omi-shambles shows that. & at the heart of all this is an a-political PM “guided” by an unelected Irishman who tells him, politically what to do, & a chancellor who is shit.
The election results show that MOST Uk serfs did not vote for LINO. Perhaps it is time for a maidan-style revolution & time that those MPs in LINO who can see what is happening, left.
Lansley’s 2012 Act was an obvious first step to privatisation. The book NHS SOS with a number of contributors including the admirable Alyson Pollock shocked me at the time.
So many ‘big wigs’ in the health service said they would improved the bill in the House of Lords and failed to act. An association of GPs were ignored.
Even the Conservatives gave up on it and in 2022 we had another health act which tried, I have read, to better integrate the elements of he health service.
I wonder if we asked health professionals to recommend a new model, what that would be like?
It’s very radical, asking people who work in the NHS. But it might be a better way.
Please look at Novara Media interview with Dr Tony O’Sullivan, Co-Chair of KONP Keep Our NHS Public.
Water: apparently the state cannot afford to buy the debt which is worth pence in the pound or the equity which is underwater. There is no money. It is better for the poor benighted consumers to be forced to keep throwing money at the current clowns in charge.
Why not start with addressing the performative cruelty at the DWP?
Or looking at John Seddons Vanguard model and trying that out to see how it can make services better with less work involved?
Quite we now have the Tory party which is rather right wing and the Labour party which is right wing and seems to be more so than the Tory party! So yes where is the party that would replace Labour? Tricky. We have the Lib Dems, Greens and various assorted left independents who have differing views and aims. Ideally we need a new (one-nation) Tory party and a new left of centre party. But how and when?
Opposition to Labour is dispersed whereas it needs to be concentrated. Without STV we have a major problem.
We need PR
And I hope PR can allow the election of capable individuals who do not belong to any party. I can see why parties arose, but we need to encourage informed debate without oppositional charades.
Everyone always seems hostile to NHS managers. We would rather spend the money on clinical services than management. Understandable of course.
But the NHS in England has a budget of over £170 billion per year, and 1.5 million staff. It requires HR and training and procurement of goods and services to enable it to run. Who decides which drugs and beds and bandages and syringes to buy. Who organises the catering and cleaning and waste disposal. The water and electricity and heating and cooling and a million and one other small things that each facility requires to operate. The absence of any one item could literally be fatal.
Doctors and nurses are trained to be excellent at delivering clinical secures. They are not trained to be excellent at management tasks. Do we really want to take highly trained medical staff and force them to spend time doing things that they are not suited or trained to do? Would it not be better to recruit people with the skills and aptitude for those tasks? Managers, in another word. As I understand it the NHS has proportionately less management personnel and cost than most other health organisations in other countries. It is under-managed.
Devolution is great if it makes the system more flexible and responsive to local demand. It will mean services vary from place to place. So there will be a postcode lottery. It also means there might well be duplication, and it will be more difficult to take advantage of the scale of the NHS eg through central procurement. So there will be a cost.
NHS England was created to insulate the NHS from political interference and micromanagement in its operational decisions, just like the police. Well, now all of the failures land on the desk of the minister. What any organisation of that size needs from people at the top is leadership, not instructions from a remote boss.
Much to agree with
John Boxall is right to mention Vanguard – John Seddon is hated by Whitehall from what I can see though. I’ve met and read Seddon, had it been me in charge I would have made him a public sector Tsar.
I’m trying to process this move. Lansley’s work was truly awful – I thought that NHS England was set up as a ready made case for privatisation and in an era of managerialism, it was only going to get bigger as the top brass pushed work away from themselves like they always do.
Maybe NHS England was just the Tory party’s version of how they were going to privatise the NHS – top down?
Maybe now, the Starmer brigade have been talking to the U.S. and maybe now the deal is to carve up the NHS regionally so that U.S. health care providers get an even distribution of services between them – they all get a portion, no one provider?
One thing for sure – the concept of trust in Streeting and mates is absent.
My concern is the possible knock on effect this will have on our S.N.H.S. Although responsibility for health is devolved, could this action affect what at the moment is the best performing health service in the U.K?
Yes. It could.
There will certainly be damage, Alex, some of it collateral and some of it planned. The collateral would occur if the revision/privatisation of the NHS England results in reduced public sector spending in England, which I’m sure is one of the prime aims (shrinking the state). This would reduce the block grants to all the devolved nations (which I’m sure is another prime aim) and would impact not just their NHS services, but all aspects of the devolved economies.
The planned damage might involve Westminster passing legislation to force the devolved nations to adopt the NHS model being planned for England. There’s no shortage of precedents for such interference. After all NHS Scotland already exceeds NHS England in meeting most targets (although UK MSM frequently lie/distort the facts) and that would be even more embarrassing for LINO than at present. My guess is that Scotland’s quickest route to independence might well be LINO attempting to force their plans for NHS England on the Scots: that might be enough to get the Scottish people sufficiently enraged and force the SNP into meaningful action.
In the 1990s the Tories foisted their lunatic “internal market” on the NHS across the whole of the UK (it was pre-devolution then). This caused huge, damaging disruption to all NHS Services and came at a massive cost, with the Big 4 extensively involved in all manner of expensive consultancy work. The current LINO proposals for what was NHS England will be no less disruptive, will come at a significantly higher cost to the nation (England) and open the way for privatisation and concomitant costs for patients. This won’t go down well in England, but would be pure poison if forced on the devolved nations. In Scotland’s case, once devolution was in place, the internal market was swiftly binned and with it the price competition between individual hospitals. In its place, regional management at Health Board level was restored, with service delivery split within the region to Clinical Services and Primary Care. As well as improving services, it resulted in reliable, standardised data collection & reporting at local and national levels, which really showed up during Covid. A return to lowest common denominator NHS services dictated by Westminster would be as popular here as the proposed visit of the king and Trump.
Thanks, Ken
Lansley’s dangerous “reforms” established NHS England but also abolished the 14 Regional Health Authorities. In their place we have far too many Integrated Care Boards which definitely suit privatisation / restricting the range of NHS provided services. They work within a defined budget and I believe are allowed to keep any surplus to distribute to the Board. I’m not aware if this has ever been done as most of them are struggling both financially and to be effective.
Thanks
The NHS is significantly undermanned as well being underresourced.
“If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge.”
“…the NHS is possibly “one of the most undermanaged organisations on the planet.”
https://www.nhsconfed.org/long-reads/nhs-overmanaged
Very good
Oops – I meant undermanaged not undermanned…
Is it finally time to try something like this?
https://brianfishhope.com/index.php/tactics/organisation
I offer some encouragement here, this was a response to your earlier question “have we lost the war” but was far to long to post in a thread
https://brianfishhope.com/supplements/139-where-do-we-go-from-here/589-where-do-we-go-from-here