The departure of Dominic Cummings and some of his colleagues from 10 Downing Street, coming as it does after we have nationally locked-down against the pandemic for a second period, combined with uncertainty over Matt Hancock’s future as Health Secretary, makes legislation to restructure the National Health Service per se a much lower priority.
Without a strong champion for NHS reform at No10 it would be unwise for Boris Johnson to bring forward major NHS reform legislation and risk having it portrayed by Labour (regardless of what it actually said) as laying the foundation for the privatisation of the NHS. To that end, the working group that was set up at No10 has also lost its momentum and seems to have dissipated.
But change is in hand through other means. This is happening on the ground through Integrated Care Systems through which various local NHS bodies and local authorities are coming together to introduce new ways of partnership working and service provision. The stronger leaders of these ICSs are themselves not in favour of them being put immediately onto any statutory footing, since such a legislative approach would presuppose a standard model rather than a bespoke local or sub-regional solution based upon local demographics, structures, resources and politics.
The arm’s length body that is NHS England is still vulnerable to abolition because of its failure to deliver during the pandemic, but legislation for structural reform of the NHS is unlikely to get close to being on the Statute Book in 2021. The challenge is to ensure that suppliers of medicines, devices and services to the NHS understand how to navigate the new terrain.
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