Health secretary could prop up unsafe services with new power, say NHS leaders

In a letter to committee chair Jeremy Hunt, seen exclusively by HSJ, the membership organisation said proposed new powers over local reconfiguration outlined in the government’s recent health white paper must include an “explicit” test that proves the intervention will not worsen patient safety.

The letter, signed by Chris Hopson and Saffron Cordery, CEO and deputy CEO respectively of NHS Providers, said: “Given the overwhelming importance of patient safety in these considerations, there should be an explicit test that use of the  [reconfiguration] power must maintain or improve safety before the power can be exercised.

“As part of the exercise of the power, the providers and integrated care system concerned, NHS England and the public should all be consulted on the relevant safety issues before the power can be exercised, with those views then made public.”

NHS Providers also said the independent reconfiguration panel, or a similar body, should also be retained, and an “appropriate threshold” introduced to govern when a minister can intervene. Currently, a local authority must refer concerns over a local reconfiguration plan to Matt Hancock, who then asks the IRP, a body of experts independent of ministers, to investigate and report back to him. The process has previously been criticised for being too time consuming.

Last month, Matt Hancock revealed he had used his existing formal direction powers to call off a proposed hospital reconfiguration in Lancashire which he said was “not justified by the clinical evidence”. The same month NHSE CEO Sir Simon Stevens warned that if there is a “political override” on a service reconfiguration that was being driven partly to prevent unsafe care, “there needs to be transparency about why that has happened”.

Speaking at HSJ’s leadership forum last week, Sir Simon Stevens also said a “retained” IRP would be “one route” through which these new reconfiguration powers could be exercised but said it was up to “the government… to decide what they want to do about the national IRP”.

The letter from NHS Providers also said:

• Only primary legislation should be able to “abolish [or] neuter” NHS England or the Care Quality Commission. It said these two bodies should be exempt from proposed secondary legislation that would allow Mr Hancock to change or abolish arms’ length bodies.
• The health bill should include a “new duty” to create independent, annual long-term workforce projections which should include input from NHS bodies, ICSs’ providers and think tanks. Currently the bill only tasks the health secretary with laying a workforce report before parliament once every five years and does not call for any independent expertise in drafting this.
• FT capital spending limit “safeguards” agreed between NHS England and NHS Providers in 2019 must be made “explicit” in the final white paper, including making public why NHSE felt it necessary to impose any spending limits on individual trusts. 

A spokeswoman for DHSC said: “New powers proposed for the Secretary of State will ensure that NHS England is accountable to the government – and ultimately those who use its services – while maintaining clinical and day-to-day operational independence.”

The article was updated on 16.42, 4 April 2021, to include a comment from DHSC.