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By British Association for Nutrition and Lifestyle Medicine (BANT)

The government’s reorganisation of the NHS risks doing more harm than good. Patients must be at the heart of it

3 min read

David Cameron’s top-down reorganisation was ‘sold’ as the reorganisation to end all reorganisations. We were promised reduced bureaucracy and improved cancer survival rates.

David Cameron’s top-down reorganisation was ‘sold’ as the reorganisation to end all reorganisations. We were promised reduced bureaucracy and improved cancer survival rates. 

Instead, it demoralised staff, distracted clinicians, wasted money and left a fragmented service failing to deliver the co-ordinated care patients deserve while the burden of chronic conditions are on the rise. Five-year cancer survival rates for some cancers remain amongst the worst in western Europe.

Now here we are in the midst of the biggest public health crisis our NHS has ever faced and the Secretary of State is determined to embark on another round of restructuring that is perhaps better described as “de-reorganising”.

Why now? Matt Hancock tells us the lesson of the pandemic is that a reorganisation is fiercely urgent. Leaving aside the obvious contradiction of Boris Johnson who insists lessons can’t be learnt until the pandemic’s aftermath, it’s not clear why this won’t be yet another focus-sapping exercise at a time of intense strain on the NHS.

With 224,000 patients now waiting over 12 months for treatment the pressures on an understaffed, underfunded NHS will only intensify. The Secretary of State didn’t even mention waiting times and cancelled operations in his statement to Parliament, an astonishing oversight given the growing waiting lists and fact that even children’s cancer operations have been cancelled in recent times. 

Addressing this backlog will require a Herculean effort to get patients back through the doors of hospitals and GP practices. It will demand our NHS’s full focus once again. 

Labour has warned that enshrining competition rather than collaboration at the heart of the NHS reorganisation would not deliver the quality of care patients needed at a time of rising chronic disease, long term conditions and an aging population.

The White Paper has sets out an aim to better integrate decision making but is unconvincing on how this will lead to better co-ordinated care for patients. Spin to newspapers breathlessly tells us “red tape” will be swept away as local clinical commissioning groups are replaced with new triumvirates of Integrated Care System boards, Integrated Partnership boards (with a seat for the private sector) and Joint Committees with Foundation Trusts all of which must have ‘regard’ for the Health and Wellbeing Boards. Is this really an end to bureaucracy? 

It’s true the rules around competitive tendering are swept away and instead the awarding of contracts to the private sector can be by discretion. Given the cronyism scandals of the pandemic, many will be wary at any attempt to institutionalise privatisation.

Improving care depends on a funded long term work force plan, a sustainable social care plan, a resourced health inequalities and public health plan. 

The White Paper contains no meaningful mention of social care and no plan to tackle the huge vacancies in the health workforce. 

The second part of the White Paper focus on the Secretary of State’s power grab. We’ve gone from “liberating the NHS” to hearing the clang of dropping bed pans reverberate across Whitehall again.

We agree that the NHS needs to be fully accountable to parliament but is more direct control the actual lesson of the pandemic? Just look at the score card: Nightingales set up and the vaccination programmed delivered by the NHS; contact tracing, PPE to the frontline in the early phase, hotel quarantine and protecting care homes all controlled by this Secretary of State.

When the legislation is published, we will consider this carefully with one thing in mind: patients. 

Patients and their families will expect ministers to explain how a structural reorganisation will bring waiting lists down, radically improve cancer survival rates and deliver the quality mental health care many people desperately need. 

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