Daily Insight: Short-sighted move?

Moves to bring more services back in-house have led to one integrated care board being criticised for allegedly “attacking patient choice”.

Devon ICB has carried out a review of its eye care providers and found “unwarranted variation” in the number of referrals for cataract surgery being sent to private providers.

But a professional body has accused the ICB of “pressuring” optometrists to refer more patients to NHS secondary services while withholding full details of the review.

The Association of Optometrists CEO Adam Sampson told HSJ the ICB was “artificially attacking patient choice” while patients were put under “inappropriate pressure” to use NHS services.

Devon ICB said following its review of 2,000 referral letters, many cases had to be re-booked with alternative providers. It added insufficient amounts of low-complexity surgery in the NHS is a risk to the service as it could result in a lack of training opportunities for new consultants.

Health and social care secretary Wes Streeting has previously defended the use of the private sector in bringing down waiting lists and said patients should have the right to choose where they are treated.

The Department of Health and Social Care said patients “have the right to choose where they go for their first appointment when referred to consultant-led care as an outpatient,” which includes private sector providers who hold contracts to deliver services for the NHS. 

The future of NHS England

NHS England is on the verge of appointing a new chair, with current chair Richards Meddings staying on until March to handle the winter challenges.

However, this is just one of many changes the organisation will face, writes our editor Alastair McLellan in his leader column.

Labour figures returning to government are concerned about the weakened state of NHS leadership, describing difficulties in gaining support for ambitious reforms, he says. Ministers, meanwhile, are struggling to get reassurances about NHS performance, but there is no appetite to scrap or merge NHSE into the Department of Health and Social Care.

NHSE’s focus is expected to shift heavily toward delivery, becoming what some describe as a “delivery machine.” Its direct influence on policy creation is already diminishing, with strategic decisions increasingly being handled by the DHSC.

Additionally, discussions around patient safety and care quality — spearheaded by Penny Dash — highlight ongoing issues, particularly around maternity care, where NHSE has faced criticism.

The incoming chair will face significant challenges, including steering an organisation dealing with the aftermath of redundancies and uncertainty about its future. Managing this transition while navigating an increasingly direct relationship with the government, will require a clear strategy and the ability to handle ambiguity.