Abolishing NHS England, large cuts, and a return to “Deliverology”

The NHS is in a state of flux, and recent announcements from the Department of Health and Social Care (DHSC) are generating understandable concern. It’s a period of significant change, and my thoughts are with the thousands of hard working, talented teams affected.

Over the past three weeks, a narrative has unfolded, revealing the government’s intent to reshape the NHS. It began with subtle shifts – through changes in key leadership positions within NHS England (NHSE). Then came the stark realities of staffing reductions, with substantial cuts announced for the DHSC and Integrated Care Boards (ICBs), all in the name of streamlining and cost control. Jim Mackey’s recent announcement, detailing plans to cut corporate staffing in provider trusts, contract support services, and introduce an NHS-wide voluntary redundancy scheme, underscored the scale of the intended workforce adjustments across all NHS organisations.

Thursday’s announcement of the abolition of NHS England was the culmination of these changes, a decisive move to consolidate power within the DHSC. Indeed, a key part of this restructuring is the creation of a new delivery unit within the DHSC, signalling a renewed focus on achieving measurable outcomes. These changes, coupled with the previously announced 50% cuts to DHSC and ICB staffing, leave no doubt about the government’s commitment to financial performance and operational improvement. Crucially, we’re also seeing a deliberate return to “deliverology,” the data-driven, target-focused approach championed by Michael Barber in the Blair era.

While the specifics of these changes will unfold over the coming months, their implications for policy, service delivery, and regulatory functions are profound. Here’s a breakdown of what these changes mean and why they are happening:

1. Financial focus: The primary driver is the financial challenge in health spending. The NHS must operate within its financial envelope to ensure sustainability.
2. Delivery issues: There has been underperformance, and a belief that autonomy is slowing the necessary changes the government wants to see.
3. Accountability: There is a strong belief the multiple layers and organisations have confused the role of delivery and performance, and there is a need to simplify this to drive change.
4. Right sizing: The non-clinical workforce growth, particularly since Covid, needs to be addressed.

What do these changes mean?

• Fiscal discipline reigns supreme: The NHS will operate under a regime of stringent financial control, with a clear mandate to adhere to its allocated budget. This will likely translate to heightened pressure on providers to deliver cost efficiencies, potentially reshaping service delivery models.
• Performance metrics aligned with political priorities: Expect a laser focus on key performance indicators that resonate with the electorate, such as reduced waiting times and improved access to primary and emergency care. This signifies a shift towards metrics that directly impact public perception, potentially influencing resource allocation.
• Centralised accountability and direction: The Secretary of State will wield greater influence over NHS operations, with a clear emphasis on top-down accountability.
• “Deliverology” as an operating model: The reintroduction of “deliverology” will drive a culture of data-driven performance management, with a relentless focus on achieving measurable targets. This signifies a shift towards a more results-oriented NHS, with a potential emphasis on standardised processes and interventions.
• Increased risk of transitional disruption: The scale of the restructuring poses a significant risk of operational disruption, potentially hindering ongoing improvement efforts. This risks delaying system changes on the ground – key to achieving the three shifts championed.

Ultimately, the goal has to be achieving better outcomes at lower costs to ensure the long-term sustainability of the health service. Achieving this means addressing the growing demand that exceeds government spending capacity. This will require working alongside local clinical leaders to design patient-centric care that prioritises the long-term health of the population and delivers outcomes that matter to individuals, while avoiding unnecessary hospitalisations and escalation of care.

It needs work across organisational boundaries to create seamless health and care journeys, and empowering local leaders to take ownership of performance improvement while fostering a culture of continuous improvement centred around improving outcomes and quality of care.

These changes will reshape the corporate structure of the NHS in England. However, we must remain focused on our core mission: improving the health and wellbeing of people. While the dust settles from these announcements, the need for frontline transformation on the ground remains as strong as ever – I look forward to supporting the leaders who are tirelessly working to deliver this change.