Huge changes to the NHS are coming. A bill to be set out in the Queen’s speech next month, and accompanied by a national digital strategy, will make official what has been on the cards for some time. England’s more than 100 clinical commissioning groups are to be replaced by 44 (or possibly 42) integrated care systems, with a remit to commission health and social care, working with local authorities. Existing rules on competitive tendering will be relaxed. Sir Simon Stevens, NHS England’s boss for seven years, will step down in July. His replacement will have less power, as the service’s independence is reduced and powers to direct it are pulled back by ministers.
Sir Simon has accepted a seat in the House of Lords and so is not, it appears, going to vanish from the scene (an intriguing possibility is that he could, at some point, become a minister). But with questions being asked about how long マット・ハンコック is likely to remain as health secretary, the situation for the whole health and care system is extremely precarious.
The already stretched NHS workforce is exhausted, と 90,000 vacancies and warnings that working conditions may lead to an exodus. Data on Covid deaths, hospital admissions and positive test results, along with vaccination rates, offer some grounds for optimism – albeit in the context of disasters unfolding elsewhere, particularly in India. But the pandemic is far from over. 周り 1 million people in the UK have long Covid 以上 1,600 remain ill in hospital. On Monday, the prime minister said that a third wave of infections is possible, whether or not new variants turn out to be able to evade immune responses.
その間, waiting lists are exploding, as the temporary suppression of demand for other services and treatments comes to an end. The number of patients having planned surgery dropped by 4.6 million last year, while GPs referred 6 million fewer people for hospital tests or treatment. One thinktank has warned that the number of people waiting could rise to nearly 10 million 沿って 2024. The social care funding question cannot be put off for ever.
One floor of a shopping centre in Bournemouth has been repurposed as a “health pop-up village」. Short-term fixes aside, the question is whether, and how, a major reorganisation can be engineered in the midst of a crisis. While regional consolidation could – and should – bring benefits, the danger is that the new bodies will be rapidly overwhelmed by a combination of staffing problems, Covid and waiting lists. In a context in which the NHS has no means of meeting patients’ needs, with political pressure mounting in the buildup to a general election, there will be strong pressure to outsource care and sell patient data.
The process by which a successor to Sir Simon is chosen is crucial. There is no organisation that means more to the public than the NHS. Its leader must not be a yes man or woman, or a crony. Following the Greensill scandal, the public will be rightly suspicious. Ministers should seek to prove them wrong, and use this period of relative calm to prepare for an unpredictable future.