Polly Toynbee: "This bill is political dynamite-a gift to the Labour party... or is it? They show no desire to get it aborted...

Even the new health secretary, Sajid Javid, seems nervous about the extent of this government power grab

NHS England chief executive Simon Stevens speaks at a service at St Paul’s cathedral, London, on 5 July to mark the 73rd birthday of the NHS.

It’s no surprise that the new health secretary has balked at a gigantic new reorganisation bill before he had even got his feet under the NHS operating table. Five million people waiting for treatment, a workforce crisis and another Covid-19 tide already cancelling treatments is trouble enough. Sajid Javid’s anxiety is shared by many, Theresa May just one of those warning of the bill’s perils. But No 10 blasted ahead with the bill this week, impervious to this political dynamite.

Whatever their merits or follies, all new re-disorganisations are risky for Tory governments, who are never trusted with the NHS. How easy it is for Labour, backed by influential NHS figures, to arouse public suspicion of Tory intentions. Even Margaret Thatcher had to back off from her radical privatising impulse, to swear between gritted teeth that the NHS was “safe in my hands”. Voters might ignore the fiendishly complex history of NHS restructuring, but they will grasp one simple, sinister point: the government is seizing control of the everyday running of the NHS, in what the Health Service Journal calls “an audacious power grab”. Any local decision can fall under populist political whim from the top.

Tory MPs should recall how Andrew Lansley’s disastrous 2012 Health and Social Care Act almost shipwrecked the David Cameron-led coalition, so loud were the voices of experts rightly warning against it. The then NHS CEO, David Nicholson, himself called that upheaval so colossal “it can be seen from space” as it broke the NHS into fragments, putting every service out to tender to anyone, public or private, enforced by competition law. Every part of the NHS had to bid and compete against others for any service: co-operation was illegally anti-competitive. This costly bureaucratic nightmare failed on every front while its privatising intent let Virgin Care and others eat into profitable community services.

Simon Stevens has spent his eight years in charge of NHS England struggling to reintegrate the fragments. This bill, the sum of his efforts, revokes the cursed Section 75 that forces tendering out NHS services. Instead, it sets into law England’s 42 integrated caresystems (ICS) designed to unite hospital, community, GP and mental services with local authority care and public health, to cooperate under one board with one budget for its local population.

But No 10 has added a nuclear ingredient: NHS England or any ICS can have its decision-making seized from it by the secretary of state or the prime minister on any pretext, and they will control appointments to those 42 boards. Expect politically obedient cronies.

This shifts the localising, accountable flavour of this bill. Where Stevens has reigned supreme, cleverly manoeuvring against the Treasury over funding, his successor will have no such creative independence, and will be subservient to political masters. The word is that Dido Harding, she of the £37bn test-and-trace failure, is out of the running, now that her riding friend, Matt Hancock, has gone. The front-runner should be the well-respected Amanda Pritchard, effectively NHS England’s deputy CEO. From outside the NHS, Leeds city council chief executive Tom Riordan is an interesting candidate, but can the job be done without deep NHS knowledge?

That’s something a contentious third contender has: Mark Britnell spent 20 years in the NHS, reaching a director-generalship. But since 2009 he has been KPMG’s senior partner for global healthcare, from where he sat on the board advising Cameron on those disastrous 2012 reforms. He surfaced in public in 2011 when caught out telling a conference of private US healthcare executives that: “In future, the NHS will be a state insurance provider not a state deliverer,” praising the competition element in the Lansley reforms that meant: “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”

He claimed those quotes “did not properly reflect the discussion” but has never denied the lethal words. Private consultants have been on a constant revolving door with the NHS: management consultant use trebled between 2016 and 2019

Poilly Toynbee The Guardian