One has to feel sorry for Simon Stevens, the long-suffering CEO of NHS England. Every chief executive has a Chairman but few have ever lambasted their own organisations to the extent that Lord David Prior last week criticised the NHS and, by inference, current and previous Secretaries of State: “Do you know any other big organisation in the world that hives off its digital strategy into a separate organisation, that hives off its people and HR strategy into a different organisation, and splits its purchasing function from its sales function? Because that’s where the NHS has been. You could not have designed something that has inherently, at its heart, more dysfunctionality.”
A major part of the problem is the sheer number of quangos and committees telling Stevens how he should do his job. The Taxpayers Alliance suggested last year that the 19 health quangos could be reduced at a stroke to seven, saving three quarters of a billion pounds and releasing top managerial time to improve NHS England.
Instead of that, Health Secretary Hancock today announced yet another meddling quango: “NHSX: A new joint organisation for digital, data and technology”. The press release says “The CEO of NHSX will have strategic responsibility for setting the national direction on technology across organisations. The CEO will be accountable to the Health Secretary and chief executives of NHS England and NHS Improvement.” Odd that. If digital technology is to be the saviour of the NHS as the Health Secretary believes and NHSX will be in direct charge of it, surely NHS England will be accountable to NHSX, not the other way around. We already have a similar problem with NHS Improvement, i.e. which is in charge of change and therefore who reports to whom? This compounds it. In Lord Prior’s language, do you know of any big organisation in the world that hives off development to outside agencies?
But it gets worse because NHS Digital already has all the responsibilities now being ascribed to NHSX and NHS Digital employs 6,000 people to do them. It also has the ambiguity of being part of the NHS and independent from it. It is also supposed to have the same relationship with social care except it does not bother to do that at all.
Today’s press release quotes Sarah Wilkinson, chief executive of NHS Digital, as saying: “This new joint venture between the organisations who currently define digital strategy and commission digital services will create cohesion in these activities by concentrating work and capabilities in one unit.” So all this digital leadership will become a single entity? Dear me no. She goes on to say: “Within NHS Digital we view NHSX as an important and welcome initiative and we are absolutely committed to working closely with colleagues in NHSX to make this new venture a success.”
Quite frankly, this is Yes-Minister-speak for “These two organisations will fight like cat and dog.” Creating a fight without purpose in the biggest public sector department, what a fantastic use of taxpayer funds.
Lord Prior is right: NHS England’s CEO needs fewer bosses but more responsibility.