DH tsar slams NHS shake-up

Sir Roger spoke to HSJ at the NHS Improvement conference on Monday (4 July), shortly before telling a roomful of clinical leaders one of the reasons for his retirement this month was his opposition towards further NHS reorganisation.

He told HSJ: “My criticism of this government is it has been so busy condemning what’s happened before when there have been more improvements [in the past 10 years] than ever before. They haven’t been prepared to look at things that have worked well.”

He added: “To say that we’re over-managed is complete baloney. To abolish all management and hand it over to a microcosm of smaller commissioners…we’ve done smaller commissioning in the past and tried bigger commissioning and settled for something in between and that seems to be the best compromise.

“I’m very worried about where we’re going to over the next few years because corporate memory will be lost. I’ve nothing against clinical engagement but we could have done it without abolishing large chunks of the NHS.”

He later took part in a panel discussion with NHS medical director Sir Bruce Keogh and national clinical director for cancer care Professor Mike Richards, entitled “Lessons for the Future”.

Asked about the future role of clinical networks, Sir Roger criticised the abolition of strategic health authorities and primary care trusts.

“The thing I’m most worried about is by tossing out SHAs and PCTs and maybe changing the networks is that these relationships will be lost, because collaboration is about people trusting each other, learning from each other and managing a common purpose,” he said.

“What we need at the moment is stability, not more change. Where we know we have tried things and they have worked, great. But we have also tried things that haven’t worked and we need to learn from that as well, otherwise we…just re-learn the same lessons time and time again.”

He added: “I’m partly leaving because I’m opposed to this substantial reorganisation of this service I love deeply and which is regarded across the world as one of the best.”

Sir Roger went on to describe the potential “risk” of increased autonomy for provider trusts.

He said: “If we give hospitals too much freedom they won’t feel part of the system and I think networks have a job to reel people in…If you give the FT system too much leeway they’re going to be regarding themselves as part of a different system not a national system.”

His comments incited an enthusiastic round of applause from the audience, which was made up of clinical leaders from across the country.

The panel was also asked by a GP commissioner how he was supposed to embed patient choice.

Sir Roger said he was “absolutely supportive” of giving patients choices over their treatments, but added: “Where I really struggle with choice is the choice of provider and the decision that competition will be the answer to everything. “

Heart surgery “pioneered” choice, he said, but GPs “almost had to bribe people” to go to hospitals other than the most local one to have operations.

“I don’t think the public are really interested in choice of provider and I can’t see it ever being a driver towards a competition, survival of the fittest, culture,” he said.

All the speakers at the NHS Improvement conference on clinical leadership in heart and stroke care paid tribute to Sir Roger’s leadership since he was appointed national director for heart disease in March 2000.

In his role, he has led the implementation of the national service framework for coronary heart disease, published the national stroke strategy and overseen significant improvements in cardiac care.