NHS England chair warns the buck now stops with ministers

Richard Meddings, Chairman of NHS England, has stated that he is not opposed to abolishing the organization, but warned that the responsibility will ultimately fall on the ministers. This implies that in the future, if problems arise, it will no longer be possible to attribute blame to an independent body.

In an interview with BBC Radio 4's "The World This Weekend," Meddings said, "There won't be an independent entity to blame, saying it made a mistake." This marks the first interview with a senior official of the agency since the government announced the abolition of NHS England. Earlier this week, the government confirmed that the administrative body would be absorbed into the Department of Health and Social Care, a move that will not affect patient care in hospitals, GP practices, and other healthcare facilities, but will change the way the NHS operates.

Meddings, who is stepping down at the end of this month, acknowledged that ministers want to be involved in the operation of the NHS, but he believes there is a subtle form of micromanagement. He pointed out that sometimes, in a single week, the government and ministers issue nearly 20 new instructions and commissions to the system. He also defended the concept of quasi-autonomous non-governmental organizations (quangos), a term used to describe publicly funded organizations that maintain some distance from the government. Meddings believes that this organizational form can introduce expertise in relevant fields and separate it from the political arena, as those in the political arena may not necessarily have the experience to operate and oversee these areas.

Meddings also emphasized that organizational changes to the NHS will not significantly alter the underlying health of the population. He explained that the NHS deals with any patient in any situation, and many poor health conditions are driven by factors outside the NHS. Meanwhile, the debate over the reforms continues. Sources say that the leadership of NHS England had an opportunity to realign its relationship with the government after the election but failed to do so because there was "too much suspicion of politicians." The source believes that the organization has become an "intellectually stagnant" bureaucracy, and its interactions with healthcare services and ministers are "incorrect."

The government, on the other hand, argues that by incorporating NHS England into the Department of Health and Social Care and cutting approximately 9,000 jobs, resources will be released for frontline services, potentially up to £500 million per year. Ministers say that the two organizations often duplicate work, leading to wasted time and resources. However, NHS sources point out that the government claims the overall waiting list for planned treatments has decreased since the election, with appointments and surgeries up by 2 million year-on-year, and these achievements were made under the leadership of NHS England. The source also noted, "A new leadership structure will not make it easier to perform surgeries and care for patients when hospital buildings are dilapidated."

These are significant structural changes for NHS England and health administration, but they will take time to implement. Merging two large organizations into one and cutting 9,000 jobs will consume a significant amount of management time and may distract from the day-to-day operation of services. Patients are unlikely to see much change in the short term.