In his eight months as UK health secretary Wes Streeting has set out low-key reforms to the health service, such as new hospital league tables and firing underperforming managers, as part of a vow to fix the “broken” NHS.
On Tuesday, after Amanda Pritchard said she was quitting as chief executive of the body that runs the health service in England, he unveiled a more dramatic part of his vision for the government’s much-touted “plan for change”: tighter Whitehall control.
“We will . . . require a new relationship between the Department of Health and Social Care and NHS England,” Streeting said. Pritchard’s successor, Sir James Mackey, had “a remit to radically reshape” ties, NHS England added.
Senior health sector figures had expected Pritchard to exit, but not before Streeting published his 10-year plan in the spring. They said the promise of a new relationship reflected the government wanting to look serious about NHS reform in the absence of a detailed strategy.
“They’ve removed Amanda because they want to look like they’re doing something,” said one person, who has advised the government. “It’s become obvious to everyone in the industry that Wes’s team came in without a plan.”
“It’s about optics,” said another health sector figure, “and Wes wants to be seen as being more radical.”
Last year the government announced a £22.6bn rise in the day-to-day budget of the NHS over two years and a £3.1bn increase in its capital budget — hailing the largest real-terms growth in day-to-day spending since 2010, outside the pandemic.
Hospital bosses welcomed the billions of pounds of new funding but said they would only keep the NHS standing still, and the commitments seemed to fly in the face of Streeting’s repeated insistence that further cash would be conditional on reforms.
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Allies of Streeting, who was shadow health secretary between 2021 and last July, have defended the time he has taken to draw up a plan, pointing to the size and complexity of the NHS and the pressures of an ageing and growing population with more complex health needs.
Streeting has set out three “big shifts” that would move the NHS from an “analogue” to a “digital” service, more care from hospitals to communities and the service’s focus from “sickness to prevention”.
But fellow cabinet ministers have raced to make their mark more visibly: deputy prime minister Angela Rayner has, for example, introduced sweeping reforms to planning and the devolution system.
One health sector figure said: “A lot of reforms would involve big arguments with unions and if he has an eye on leadership of the Labour party, is he willing to make those big moves?”
Pritchard’s resignation coming one day after she met Streeting suggested he had been pushing for her departure, one health official suggested.
Streeting told reporters on Tuesday that he had not asked Pritchard to step down, but only last month two parliamentary committees called her leadership into question, describing her as “complacent” and “out of ideas”.
One government official said Pritchard “chose to resign and it was all very amicable”, noting that ministers had been clear since last summer that they “want a closer working relationship between NHSE and DHSC”.
Streeting’s reform agenda would inevitably mean the two organisations shrinking, the person added.
Mackey — who is chief executive of Newcastle Hospitals NHS Foundation Trust and has held various health service roles — is expected to be in post for several years, overseeing a far-ranging restructuring and reduction in the number of health officials.
Richard Sloggett, who was a special adviser to then Conservative health secretary Matt Hancock and now runs a health consultancy, said Mackey had “done the binding on probably the most important agenda” by cutting waiting times for non-urgent treatment after becoming national director of elective recovery in 2021.
In that role Mackey had also pointed to how the government and NHS England could better work together, devising a plan for reducing backlogs that positioned “Jim as the operational lead, but very much appointed by ministers”, Sloggett said.
Another healthcare executive who has worked with Mackey said he would be “much more pragmatic and much more results-oriented” than Pritchard.
One way in which this would be evident was in a different attitude to the private sector, he predicted, adding: “Amanda never really either understood or liked, but tolerated, the private sector, whereas Jim sees them as part of the solution.”
This month Streeting announced Penny Dash, a former hospital doctor and partner at McKinsey, as the new chair of NHS England from March. He also brought in Tom Kibasi, chair of several NHS trusts, to draft the 10-year plan — a move that health officials interpreted as them being sidelined.
Sarah Woolnough, chief executive of The King’s Fund, a health and social care think-tank, said Mackey was taking the helm “at an extremely critical time for the NHS”, with ministers due to set out big changes and the service grappling with high demand and budget pressures.
“It is crucial that the two organisations [the health department and NHS England] continue to work well together but equally important that NHS leaders retain operational and clinical independence for the day-to-day running of the service,” she added.
