Hancock decries ‘layers of management peering over staff’s shoulders’

Mr Hancock also appeared to indicate there would be major change to the Care Quality Commission’s inspection framework. 

He today launched the first part of the NHS People Plan along with his drive to “bust bureaucracy”, and in a speech at the Royal College of Physicians said the plan was “aligned to this vision of an empowered culture”.

He said he wanted to build a culture where staff are trusted to use their professional judgement to “do the right thing… instead of appearing to assume that someone will do the wrong thing unless they have layers of management peering over their shoulder”.

“Together we will build a system of distributed authority, where decisions are made as close as possible to where the information is,” Mr Hancock said.

He stressed that the pandemic forced the health service to decide “which rules and processes are central to the NHS mission… and how the law is over interpreted”.

“This bureaucracy will not be coming back – in the future I want to go even further,” he said.

There have been multiple attempts to reduce bureaucracy in the NHS, often initiated and trumpeted by senior ministers. The immediate previous health secretary, Jeremy Hunt, commissioned a major review of “cumbersome bureaucracy” in 2013. It found the “national burden of bureaucracy is much bigger than originally thought”.

On the CQC, Mr Hancock said during the pandemic it had “adapted [its] inspection model to the new reality, using data and feedback to identify problems in real time”.

“When we made these changes the sky didn’t fall in,” Mr Hancock said. “We cannot and will not revert back to before.” This could make it very difficult for the CQC to routinely publish accurate ratings of care quality at different providers.

Mr Hancock, in a wide ranging speech, addressed social care reform and said “we need to get more money into social care to fix the funding shortage… achieving this will require bold reforms”.

“We need to look beyond healthcare… we must move away from spending as an NHS pound or a council pound, but a Darlington pound or a Dudley pound,” he said. “We need local authorities in the NHS to plan and budget together, work together and be accountable together to local people.”

Mr Hancock stressed this collaboration was needed “at a national level too”.

“Just as we need more joined up, collegiate working from the ground we need the same at the centre,” he stressed. “Our national healthcare institutions are too siloed, in many cases by law under the 2012 act. Huge amounts of energy are wasted.”

Mr Hancock also covered healthcare technology in the speech and said: “All consultations should be tele-consultations unless there is a compelling clinical reason not to.”

“This crisis has shown patients and clinicians alike want to use technology,” Mr Hancock said. “They don’t want to sit around in a waiting room if the service can come to them at home.”

“We shouldn’t patronise older people by saying they don’t do tech,” he said.

On digital, Mr Hancock said “all consultations should be teleconsultations unless there’s a compelling clinical reason not to”.