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9 hours ago
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Wes Streeting will axe thousands of jobs at NHS England after his ousting of its chair and chief executive in what health service staff fear is a power grab.
The health secretary’s plan follows Amanda Pritchard’s shock announcement on Monday that she was stepping down as the organisation’s chief executive next month.
She will be replaced, for the foreseeable future, by Sir Jim Mackey, the widely admired chief executive of the NHS trust that runs the acute hospitals in Newcastle upon Tyne.
Streeting plans to gain and assert much more control over NHS England as part of his mission to usher in “a new era for the NHS” and revive the public service that voters care most about.
This will include shrinking the size of the body in operational charge of the health service through deep cuts to its 13,000-strong workforce, and it doing much less in the future.
He plans to end the situation whereby separate teams of officials at NHS England and the Department of Health and Social Care (DHSC) cover the same area of health policy, such as primary care, which he regards as an unnecessary “duplication” of roles. While those teams often agree on changes needed, disagreements between them have also held up key policy initiatives.
However, NHSE personnel will bear the brunt of job losses, which will be “significant” in scale, it is understood. Some teams will be merged, including the two organisations’ respective communications teams, amid much closer joint working.
A Whitehall source said: “In future, NHS England will still play a crucial role but it will have a smaller and leaner role. It will be a smaller role than what it’s currently doing, which is a lot, but which involves a lot of duplication.
“Historically there have been too many disagreements [between the overlapping teams of officials] and duplication of tasks and roles and responsibilities.”
In an example of the tension that can occur, Streeting’s desire to publish a new plan to tackle the long waits patients can face for urgent and emergency care, such as A&E treatment and getting an ambulance, has been delayed after NHS England raised doubts about whether such a plan was needed and what genuinely new initiatives could be included, one senior official said.
Streeting has already removed Richard Meddings, NHS England’s Conservative-appointed chair. He has chosen Dr Penny Dash – a doctor who shares his zeal to radically reform the NHS – to replace Meddings, in a move NHS insiders and health policy experts say will strengthen Streeting’s grip.
Meddings was “disappointed” and “dismayed” when the minister told him he wanted him to quit a year before the end of his four-year tenure, he told the Sunday Times recently.
Dash is the chair of the north-west London integrated care board – a regional grouping of NHS trusts and local councils. She is a “no-nonsense character who is happy to provide robust challenge to senior people in the NHS about the progress they are, or aren’t, making”, according to someone who has worked closely with her.
One former DHSC special adviser said Pritchard’s resignation will give Streeting more power and “is another sign of power moving back to DHSC and ministers. With Meddings and Pritchard now gone, ministers are fully in control.” The layoffs will further weaken NHS England, they added.
But Sarah Woolnough, the chief executive of the King’s Fund thinktank, issued a veiled warning to Streeting not to impinge too much on the freedom that NHS England was given as a result of then health secretary Andrew Lansley’s controversial shake-up of the service in 2012.
“It is crucial that the two organisations 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 said.
Pritchard explained her “hugely difficult decision for me to stand down” saying it was her belief that the NHS needed new leadership to implement the government’s forthcoming 10-year health plan.
However, NHS sources said that in recent meetings Streeting had encouraged her to consider her future, given the major reforms he was planning, and that as a result she concluded that she should go. In an unusual move, two Commons select committees last month criticised her alleged lack of drive and dynamism.
A well-placed source said that the office of Christopher Wormald, the cabinet secretary – who until recently was the DHSC’s permanent secretary – had advised Streeting to “do it nicely” when announcing Pritchard’s exit, and “make it look like she was leaving on her own terms”.
