Jeremy Hunt backs calls to abolish NHS England in health management reforms

Former health secretary Jeremy Hunt has backed calls to abolish NHS England amid a suite of reforms to how the service is managed.

A new report from think tank Policy Exchange has argued for overhaul of NHS management structures, training and incentives to improve the system’s performance and productivity – as opposed to focusing on reducing or increasing management numbers.

The shadow chancellor said: “It is without doubt that effective management is a requirement if we want to deliver a high-performing and more productive NHS…. we must look more closely at the skill sets and competencies we wish managers to develop.”

Greater focus on competencies, incentives and placement of NHS managers, rather than headline workforce numbers alone, must be prioritised, the authors of the report, titled: ‘Just About Managing: The Role of Effective Management and Leadership in Improving NHS Performance and Productivity’, argue.

While they call for significant reforms to NHS bureaucracy, including to abolish NHS England – which leads the health service in England commissions specialist services – and establish a management and oversight board in the Department of Health and Social Care (DHSC). 

Watchdogs such as the Care Quality Commission (CQC) should be reviewed, the report, based on 40 expert interviews, recommended, as well as launching a new feedback and complaints service called NHS Patient View, to address the current “inconsistent” approach.

According to Freedom of Information (FoI) requests sent by the think tank, more than 80 per cent of NHS hospital trusts and service providers have not dismissed any managers in the last year for gross misconduct or poor performance. 

It also found the NHS had fewer managers than international and sector comparators, with just six per cent of workers at each acute hospital trust having management responsibilities.

Professionals with no medical background should be recruited into operational management via a mid-career social enterprise scheme, such as Teach First, which enlists into education, while existing managers should have competency appraisals and a focus on boosting skills.

Lead author John Power said: “Effective management is key to improving performance, but it would be a mistake to think that ‘more managers’ will inevitably lead to NHS improvement. 

“We have created more managers, but they aren’t optimally placed. At the same time we lack key competencies – such as data analytics – in the places where it is needed most.”

The review comes in the wake of Lord Ara Darzi’s independent review of the NHS, which saw Prime Minister Sir Keir Starmer declare the health service must “reform or die”.

An NHS spokesperson said: “As Lord Darzi has said, a reorganisation of NHS England is neither necessary nor desirable, and it was a top-down reorganisation in 2012 – similar to what Policy Exchange is recommending today – that Lord Darzi found was a “a calamity without international precedent”.

“On the back of his important review, NHS England will continue to work very closely with the Department of Health and Social Care, including on a 10 year plan to tackle the huge issues facing the health service.

“In the meantime, more than a third fewer staff work in NHS England than in 2022 – saving almost £0.5bn which is being reinvested into patient care – and actually, NHS England is already implementing some of the recommendations from this report to improve and better incentivise managers, including by developing a new competency framework for the first time ever.”

A Department of Health and Social Care spokesperson said: “Lord Darzi’s investigation found that the top-down re-organisation of the NHS introduced in 2012 did lasting damage to the capability of the health service.

“The Secretary of State has been clear the NHS needs radical reform, but the last things patients on a waiting list want is years and billions of pounds wasted on another top-down reorganisation.

“Lord Darzi’s findings will inform our 10-year plan to deliver the care patients need by radically reforming the NHS and building a health service that is fit for the future.”