The following Statement was made in the House of Commons on Thursday 13 March.
“With permission, I would like to make a Statement on the future of NHS England.
Since coming into office, this Government have made big strides in fixing our broken NHS. Under the Conservatives, the NHS suffered years of industrial action, costing taxpayers billions and costing patients more than 1 million cancelled operations and appointments. We negotiated an end to the resident doctors’ strike within three weeks. We have delivered the 2 million extra appointments we promised in our first year, and we did it seven months early. After 14 years of rising waiting lists under the Conservatives, we are finally turning the tide, cutting waiting lists for five months in a row, cutting waiting lists through the winter pressures and cutting waiting lists by 193,000 so far and counting. We have agreed the GP contract with GPs for the first time since the pandemic—our first step to bringing back the family doctor—and we have delivered the biggest uplift in hospice funding for a generation.
However, there should be no doubt about the scale of the challenge ahead. We inherited an NHS going through the worst crisis in its history, so there is no time to waste. We inherited public finances with a £22 billion black hole, so there is no money to waste. The urgency of the crisis means we have to go further and faster to deliver better value for taxpayers and better services for patients—something the Conservative Party cannot even begin to speak to a record on.
The independent investigation into the National Health Service by the noble Lord, Lord Darzi, traced the current crisis back to the 2012 top-down reorganisation of the NHS by the noble Lord, Lord Lansley. The Darzi investigation said the reorganisation was ‘disastrous’ and a ‘calamity without international precedent’ that ‘scorched the earth’ for health reform,
‘the effects of which are still felt to this day’.
The Health and Social Care Act 2012 established more than 300 new NHS organisations, created a complex and fragmented web of bureaucracy and, to quote the Darzi investigation,
‘imprisoned more than a million NHS staff in a broken system’.
Today, we are putting the final nail in the coffin of the Conservatives’ disastrous top-down reorganisation of the NHS.
There are more than twice as many staff working in NHS England and the Department of Health and Social Care today than there were in 2010—twice as many staff as when the NHS delivered the shortest waiting times and the highest patient satisfaction in history. Today, the NHS delivers worse care for patients, but is more expensive than ever before. The budget for NHS England staff and admin alone has soared to £2 billion. Taxpayers are paying more, but getting less. We have been left with two large organisations doing the same roles, with an enormous amount of duplication.
It is especially in times like these, when money is tight, that such bloated and inefficient bureaucracy cannot be justified. However, even if the Conservatives had not left a £22 billion black hole in the public finances, the Prime Minister would still be announcing the changes he is today, because every £1 that is wasted on inefficient bureaucracy—in good times or bad—is £1 that cannot be spent on treating patients faster, nor can it be spent on fixing our crumbling schools, lifting children out of poverty or putting money back into people’s pockets. There is always a duty on Ministers to get as much value for taxpayers’ money as is possible, and I cannot honestly say that it is achievable with the way that my department and NHS England are set up today, nor can I say that the current set-up is getting the best out of the NHS.
I am sure Members will have heard their local NHS leaders complain about the top-down way in which the NHS is run. It is something I have heard for years. Now that I find myself at the peak of this enormous mountain of accountability, I do not just recognise the complaint; I agree with it. Front-line NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy.
In the Hewitt review, the former Health Secretary, my right honourable friend Dame Patricia Hewitt, reported that one local service was required to send 250 reports and forms to NHS England and the Department of Health and Social Care in a single month. That is time and energy that is not being spent delivering care for patients. The review also concluded that having two organisations doing the same jobs has led to
‘tensions, wasted time and needless frictional costs’.
Since coming into office I have sought to correct that, by building a one-team approach between my department and NHS England, working towards our shared mission of building an NHS fit for the future. Today, the Prime Minister has announced that we are turning one team into one organisation.
I acknowledge that there are talented, committed public servants working at every level of the NHS and my department, including at NHS England, who I have had the privilege of working with over the past eight months. The reforms we are announcing today are not a reflection on them. They have been set up to fail by a fragmented system that holds them back. The actions we are taking today will change that.
Work has already begun to strip out the duplication between the two organisations, and bring many of NHS England’s functions into the department. NHS England will have a much clearer focus over this transformation period. It will be in charge of holding local providers to account for the outcomes that really matter: cutting waiting times, and managing their finances responsibly. And it is tasked with realising the untapped potential of our National Health Service as a single-payer public service: getting a better deal for taxpayers through central procurement; being a better customer to medical technology innovators, to get the latest cutting-edge tech into the hands of staff and patients much faster; and being a better partner to the life sciences sector, to develop the medicines of the future.
Over the next two years, NHS England will be brought into the department entirely. These reforms will deliver a much leaner top of the NHS, making significant savings of hundreds of millions of pounds a year. That money will flow down to the front line, to cut waiting times faster and deliver our plan for change. By slashing through the layers of red tape and ending the infantilisation of front-line NHS leaders, we will set local NHS providers free to innovate, develop new and productive ways of working, and focus on what matters most: delivering better care for patients.