Roy Lilley, nhsManagers.net eLetter,19 May 2025, https://ihm.org.uk/nhsm/
‘Something doesn’t add up. How could it happen…’
As one reader put it; ‘How is it possible to wake up one morning and decide that NHSE must be demolished’.
A better question is, ‘why’?
On the basis of no published evidence, our great leader says there is… ‘significant duplication’ between NHSE and the DHSC’, and this is his primary reason for the reorganisation…
How ‘significant’? Dunno.
… ‘overlapping responsibilities and inefficiencies’… policy and strategy functions traditionally associated with the DHSC had become ‘embedded within NHSE’.
How overlapping?
What responsibilities?
How deeply embedded?
Dunno.
As far as I know, there was no overwhelming argument to bring in the demolition squad. It says to me, perhaps a careful review? A strategic realignment? Maybe.
NHSE is, broadly responsible for ten headlines;
- Commissioning Healthcare Services
- Strategic Leadership and Policy Implementation
- Performance Management
- Quality and Safety Oversight
- Financial Oversight and Resource Allocation
- Service Transformation and Modernisation
- Public Health and Prevention
- Workforce Planning and Development
- Digital Transformation and Data Management
- Emergency Preparedness and Response
… if there is an overlap in any of this, it is because various ministers at the DH+ have tried to muscle-in on the NHSE (an arms length body), and take control.
The DH+ has no skills or capacity to do any of these ten vital responsibilities.
There is no justification, whatever, for closing NHSE.
A reset? Yes, why not? Ploughing-on with closure, no plan, no impact analysis. Bonkers.
There must be more to this than meets the eye.
NHSE now in limbo, left firefighting.
Fighting fires in ICBs, dousing fires in NHSE, stamping out fires in the DH+ and somehow trying to kindle a fire to cut NHS waiting lists, that are, again, on the up.
Distracted and confused. Making chaotic decisions. For instance…
Last week there were two announcements.
Experienced managers offered £40,000 to relocate away from where they are working, to someplace else that is struggling. Help them to get onto the front foot.
And…
Experienced managers were being offered up to £80,000 to clear their desks and retire early, with the rebirth of the Mutually Agreed Retirement Scheme.
Experienced managers relocating? They are bound to have families, partners, mortgages, roots, friends, kids in school. Up-end all that for forty grand… I don’t think so.
Experienced managers offered a MARS settlement, get them off the payroll? It’s only going to appeal to time served, skilled managers that are close to retirement. Eighty grand to tide them over until they can call down their pension… very nice, thank you.
So, do we need experienced talent or not?
A chaotic system, resulting in conflicting decisions.
Are we recruiting or reducing? Fixing the problem or creating a new one? With no idea what the impact of all this really is.
Streeting has one job… reduce waiting lists… they are going up and most likely to continue to do so, all the time management is distracted…
... he is desperate to take over the NHS and run it…
… no thought about what happens when you pull the plug on a huge organisation and expect it to keep ticking over.
Meanwhile, his ten-year plan bounces around the system. There’s been two attempts to finalise the draft by two different authors and still the final text isn’t agreed.
There is no justification for causing this chaos but I think, there is a reason.
The Cabinet Office Minister Pat McFadden is struggling with his target to reduce the civil service headcount.
He aims for a 12,000 reduction by 2030… that’s about 2,400 a year. Just under 50 a week.
Looks easy until you look at the complexity of civil service redundancy protocols. Insiders tell me it ain’t gonna happen.
Streeting has confessed his difficulty in cutting what he calls, the NHS’s ‘bloated bureaucracy’.
His big problem, no money for redundancy payments from the Treasury.
However, work with McFadden who has plenty of redundancy money, close NHSE and by the time of the next election… McFadden’s target accomplished and Streeting gets his way.
There you have it… over a weekend policy is formed and chaos ensues.
Somebody told the new chief executive, who was recruited to get the NHS back on its feet but suddenly had the feet pulled from under him.
Somebody told the incoming chair, an ex-McKinsey consultant who will well recognise the folly of this, that her job was to shut up shop, on the basis of no evidence whatever… she will now be remembered for the chaos.
If there is another explanation to all this… let them tell us.
It’s not called government, it’s not called management, it’s not called reform, it’s not called reorganisation, it’s not called anything other than what it is…
… politics.
Stephen Kinnock MP
Minister or State for Care
Department of Health and Social Core
39 Victoria Street
London, SWIH OEU
Dear Minister,
16 May 2025
Following the very worrying Issues around patient safety and value for money raised by the recent Sunday Times investigation, I am writing to urge the Department of Health and Social Care to Initiate a review Into the current use and oversight of independent sector providers (ISPs) in NHS-funded cataract surgery.
The College has for some time expressed deep concern about the unintended consequences of moving the majority of NHS cataract surgery to ISPs. These concerns appear to be shared by your officials too; as reported by the Sunday Times, a leaked ministerial briefing note stated that “NHS England have concerns covering value for money, unnecessary operations, impacts on workplace and training, poor follow-ups and patient safety”.
Recent research shows that between 2018/19 and 2022/23 NHS spending on 1SPs delivering cataract surgery increased by at least 380% to £282 million annually and the overall proportion of the NHS ophthalmology budget spent on cataracts jumped from 27% to 36%. This shift has led to funding, workforce and Infrastructure being diverted here at the expense of resourcing for conditions such as glaucoma and age-related macular degeneration that can cause Irreversible sight loss if not treated swiftly.
Concerningly, 67% of ophthalmology clinical leads feel that Independent sector provision has had a negative impact on patient care, and commissioners have told us they are unable to properly control their cataract spend and, therefore, effectively resource services that can prevent Irreversible sight loss. This Is backed up by recent research that found in 2021/2022 14% of ISP-delivered cataract surgery was on a non-contracted basis – rising to 25% In seven Integrated care boards.
This question of value for money and making the best use of scarce resources Is paramount. A review must address Issues Including non-contracted activity, potential upcoding practices, and payments in referral pathways. Equally, patient safety must be central – particularly in relation to the management of post-operative complications.
To ensure we have comprehensive, sustainable eye careservices Into the future, we must invest In NHS ophthalmology – Its workforce, training, estate and Infrastructure. We hope that the forthcoming 10 Vear Plan and Long Term Workforce Plan refresh will reflect these priorities.
I look forward to working with you and all stakeholders in the eye care sector to address the challenges relating to Independent sector provision of NHS-funded cataract surgery to ensure we do all we can to prevent avoidable irreversible sight loss.
Yours sincerely,
Professor Ben Burton President, The Royal College of Ophthalmologists