Is it brave, or risky, to announce an NHS reorganisation in the midst of a pandemic?

When the Health Secretary published his White Paper setting out how the NHS in England is to be reformed through another major restructure, he claimed there was “no better time than now” to do it.

Certainly, the pandemic has highlighted the importance of agencies, commissioners and providers working together effectively and efficiently.  

It has also shone a spotlight on the importance of population health rather than just patient health.  But it would also be understandable for healthcare staff to question the wisdom of such a significant structural upheaval when we remain in the grip of a pandemic.

Thinking back to my own career in the NHS I experienced a few full-scale reorganisations plus a couple of smaller shake-ups.

Whilst I relished the leadership opportunity around organisational change, I recall the disruption and huge uncertainty such reorganisations can cause at all levels.  

Distracting

Yes, it comes with the territory.  But for those affected (and even those who don’t know whether or not they will be affected) these processes can be very distracting. 

Staff can become consumed by thoughts of ‘how is this going to impact me?’ and ‘will I have a job at the end of this?’ Is now really the right time to distract staff in this way? The former Health Secretary Jeremy Hunt described it as “the right and brave thing to do.” But to my mind it’s also a risky thing to do.

Staff have been working under [pandemic] pressure for almost a year now and many are completely exhausted. So, I worry about the NHS workforce and its capacity to deal with another major reorganisation.  People are so committed and will go the extra mile – but could this be a tipping point for many?

High waiting lists

Figures published this week show the number of people waiting more than 12 months to start hospital treatment in England stood at 224,205 in December.

That’s the highest since April 2008 (and compares with 1,467 in December 2019). So on top of all the current pressures, managers and frontline staff are faced with a mountainous backlog to address.

Meanwhile social care continues to struggle. When Boris Johnson first took office he announced – on the steps of 10 Downing Street – that he would “fix the crisis in social care once and for all” with a “clear plan.”

Yet here we are, 19 months later, on the day of a major announcement, and yet there’s still no sign of that clear plan.

The White Paper is entitled Integration and Innovation: working together to improve health and social care for all. Clearly, the Lansley reforms did not work in many ways – and I welcome today’s White Paper as an acknowledgement of that.  But could this planned reorganisation be just as disruptive, in the context of the ongoing pandemic?  

A different kind of bureaucracy?

I also find the latest reference to ‘removing bureaucracy’ interesting when invariably, in this context, reorganisation will result in new structures being created which could be viewed as ‘a different kind of bureaucracy’.  

But having said all that, I do think the Government is right that we have to do more around population health locally to ensure people are supported to stay healthy. And for that to happen it is essential that a genuine (and continued) attempt to reduce health inequalities must lie at the heart of the changes.

I also think there’s a debate to be had around whether people expect too much from the NHS.  For some working flat out delivering care on the frontline, talk of reorganisation will just be background noise. But I’m also sure that many NHS staff will be taking a deep breath and thinking “here we go again.”