‘Brutal’ cuts to ICBs and NHSE slammed by ex-health secretary

The former Labour health secretary, who is chair of Norfolk and Waveney Integrated Care Board, said she feared trusts would now be “micro-managed” by the centre and ICBs “will struggle to fulfil their statutory functions”. It follows the announcement of 50 per cent cuts to ICB budgets and the abolition of NHS England last week.

The influential NHS and Labour figure, who led a government-commissioned review of the role of ICBs, made her intervention during an exclusive HSJ interview, originally planned to announce her retirement as ICB chair (see box below).

But after an extraordinary week, she said she was choosing to “speak truth to power” about how the reforms are being carried out because she understood this would be incredibly difficult for senior leaders who remain in the system.

On how national leaders announced the two decisions, she said: “It’s an appalling way to treat people – all these deliberate headlines about bureaucrats, and then claims of looking after people, when the reality… is absolutely brutal.”

Dame Patricia said abolishing NHSE was not in itself “necessarily a bad idea in principle” – but: “The real problem is combining the abolition of NHSE with hugely increased micromanagement from the centre.”

She added: “I have deep concerns, both about the policy decision that trusts should report to the centre and the cuts across the current NHSE and Department of Health and Social Care.

“If [health and social care secretary Wes Streeting] was proposing to combine abolition with decentralisation… then I’d be all for it. But as it stands, it’s one more tightening of the screw, I fear.”

She questioned whether government could hit its flagship pledge to meet the 18-week waiting target if it takes such a centralised “micro-managed” approach.

ICBs will ‘struggle to fulfil their statutory duties’

Dame Patricia said her experience as health secretary from 2005-07 meant she understood the “desire of ministers to have a nice, simple line of sight down to everything, but I think this is the wrong way to get it”.

She also questioned the government’s move to remove the performance management assurance role from ICBs, and the return to a focus on organisational incentives.

“If you scrap the principle of [the centre regulating] ‘with and through ICBs’, what incentive does any hospital board have to work with their ICB [on performances and finances]?… The two-year [financial reset] turnaround programme is calling [trust leaders] inexorably in the other direction [to working with ICBs],” she said.

Furthermore, slashing ICB budgets by 50 per cent would “sadly [mean] ICBs will struggle to fulfil their statutory functions, not to mention taking notice of coroners’ reports and independent enquiries”.

“There simply won’t be capacity for system leadership. So, when ministers and MPs complain about hospital X’s lousy performance, they need to remember they scrapped the system working that was an essential part of sorting out the top performance issues.”

Centralisation plans risk making turnaround ‘almost impossible’

Dame Patricia repeatedly stressed her respect for NHSE CEO Sir Jim Mackey and Mr Streeting, calling the health secretary a “brilliant leader”.

But she argued: “By putting system working to one side as a way of clarifying the existing somewhat ambiguous relationship between trusts and ICBs, [Sir Jim] actually risks not making things better, not achieving goals of turnaround… but actually making it almost impossible to achieve turnaround and hit the target because [of this over-centralisation].”

The outgoing ICB chair said she agreed there is too much bureaucracy, but she fears the current restructure will, in some ways, make it worse. NHS leaders have already been “groaning under the weight of micromanagement from the centre for the last three years, at least,” she said. “You have highly respected people saying, privately or publicly, it’s the worst they’ve ever seen.

“[Our chief executives] should be really focusing both on strategy and making sure they’ve got the right people doing the right jobs [but instead] they’re spending most of their time in meetings and preparing for the meetings and dealing with the phone calls from the centre. It’s a nightmare.”

Dame Patricia revealed she had considered using her government-commissioned inquiry into ICBs in 2023 to recommend NHSE and DHSC work “far closer together, via merged teams and shared appointments”.

“It is nonsense, for instance, to have two primary care teams working out how to deliver on the ‘family doctor’ pledge – and, frankly, the DHSC team is much better in most cases than NHSE’s,” she said.

“Sadly, the senior leadership of NHSE made it clear this was unacceptable: they said, in terms, that ministers come and go, but ‘we are your allies; we are here for the long-term; don’t give [then Conservative health secretary] Steve Barclay another weapon to use against us’. Faced with that, of course I pulled my punches — but we were all wrong about ‘being here for the long-term.’”

A DHSC spokesperson said: “The abolition of NHSE will allow us to devolve more resources and responsibilities to the frontline. We aren’t going to replace micromanagement from NHSE with micromanagement from DHSC.

“Creating a more efficient, leaner centre will also free up capacity and help deliver savings of hundreds of millions of pounds a year which will be reinvested in frontline services, including cutting waiting lists and tackling health inequalities.

“Thanks to our reforms and work so far, we’ve already made progress on our mission to cut waiting lists – delivering an extra 2 million appointments seven months early, and cutting the list by 193,000 since July.”