The must-read stories and debate in health policy and leadership.
- Today’s chance to dust off your CV: DHSC hiring three £110,000 policy directors
- Today’s take on systems: ICSs should focus on relationships as much as governance
Matt Hancock’s resignation could hardly have come at a more irritating time for fans of the government’s proposed health and social care bill.
His departure and replacement by Sajid Javid emerged on Saturday night – less than four days before, it had been hoped, the bill might be published before Parliament.
Those working on integrated care systems wanted its Commons second reading to take place before the summer break. This would have given NHS officials enough legal headroom to begin appointing designated chairs and chief executives ahead of ICSs taking on statutory status, and given a realistic chance of the other legal necessities being in place in time for an April 2022 go-live.
But it would be a very big call for Mr Javid to press ahead immediately with this substantial bill, which he has had no time to get to grips with, in full knowledge of the toxicity of NHS reform and top-down reorganisations for the Conservative Party, in particular.
One option – favoured among the NHS’ supporters of this legislation, and today put forward by new NHS Confederation chief Matthew Taylor – would be for Mr Javid to strip out the more controversial parts of the bill. These are the proposals least favoured in the NHS anyway, which would give the health secretary greater power of direction over NHS agencies, including NHS England, and over local service reconfigurations.
We will find out soon if Mr Javid will take that bait, and put forward any form of bill over the next 10 days, in time to stick to the NHS implementation timetable (which would anyway have been very tight).
If he doesn’t – what then?
When the NHS has been working towards these changes – and already adopting them to a large extent – without legislation, it is hard to see another 12 months’ hiatus as a total disaster.
Yet the real fear of supporters of these reforms is that they could now be derailed altogether, following seven years of hard consensus building under Sir Simon Stevens.
The new health and social care secretary may get his own ideas (perhaps he should focus on fixing social care first?), a new NHS England chief executive could well have other priorities too, and controversy and disquiet around enormous waiting lists could shift NHS political thinking altogether.
Mr Taylor cautions: “Having a clear direction which is broadly supported is [an] incredibly valuable thing. It needs to be cherished and protected.”
As one of Tony Blair’s top advisers the new Confed chief knows that even in those heady days of plentiful funding and reform, policies were foisted upon the NHS, rather than evolved bottom-up in the manner of ICSs. Rare is it that the service itself broadly agrees on its policy priorities, let alone the centre of government, and even – on a good day – the opposition.
The danger is that Mr Javid will struggle to see the value of all this, compared to the unappealing task of rolling into the Commons with someone else’s “top down reorganisation of the NHS”.
Will three become one?
The well-respected chief executive Tom Cahill has announced he is to leave Hertfordshire Partnership University Foundation Trust’s after 12 years as its chief executive and 16 years working in the trust.
He has not announced his next steps but for a man who led his trust to an “outstanding rating”, not to mention the HSJ accolades he has received over the years, he is likely to be a leader with many options before him.
What is less certain is the development of the Hertfordshire and West Essex ICS as a number of senior level departures have recently left Hertfordshire-based NHS providers.
Nick Carver, long-term leader of East and North Hertfordshire trust, announced last month that he is also stepping down, and Elliot Howard-Jones is on an interim CEO contract at Hertfordshire Community Trust.
As one astute reader said, a chance is now available for the three trusts that cover mental health, community and acute to come together under one chief executive – HSJ will of course keep you up to date on any developments.