A welcome first step to fixing the NHS
NHS England came into being with Andrew Lansley's botched reforms in 2012. The ambition was to depoliticise the health service. The result instead was to strip the last vestiges of accountability from its structures.
Rather than shielding politicians from criticism for the health service's performance behind the operational independence of NHS England, the effect was to shield the health service from criticism while politicians were held accountable for a system they were seemingly unable to influence.
Sir Keir Starmer's decision to abolish this ludicrous structure is therefore most welcome. A situation where an unelected bureaucracy was handed an annual budget of £169 billion to spend with minimal oversight from Parliament was never going to last, and its rectification is a symbolic move towards sanity. The challenge now is to make sure that it is more than that.
Having made the right decision to abolish the world's largest quango, the task facing the Labour Government is to come up with a replacement system that addresses the health service's flaws. There should be no understating the scale of this task: fixing the NHS has defeated politicians practically since its inception. However, it is heartening that Sir Keir and Health Secretary Wes Streeting appear willing to take it on.
The fundamental problem with the NHS remains as it has always been: the lack of any incentives for performance. Competitors in a private system face the discipline of the market, and the knowledge that patients will shun poor performance or high prices generated by waste. There are few, if any, such mechanisms through which patient dissatisfaction can act to discipline the NHS.
Abolishing NHS England will not address this failure if it simply results in a command economy with ministers at the top of the chain. While it will still be an improvement, providing some means for public pressure to influence the health service, we must surely hope more radical reforms will follow.
Having made this first step, Sir Keir should now set out how he intends to see this change in governance translate into improvements in the NHS. Reforms intended to scrap bureaucracy and red tape are welcome, and could potentially lay the groundwork for the Government to make bold interventions of the sort needed. Whether it will do so, and whether it will succeed, is another question entirely. The proof, as the saying goes, will be in the pudding.
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