Heraclitus, the Greek philosopher said, “Change is the constant in life”.
The Prime Minister and Secretary of State’s announcements (13 Mar 25) herald another period of significant change for the NHS. The need to close a multi-billion-pound black hole will see a strategic re-set. In a transition expected to take up to two years, the Department of Health and Social Care (DHSC) and NHS England (NHSE) will increasingly merge functions leading to NHSE’s formal abolition. In parallel, Integrated Care Boards have been told to cut their running costs by 50%, and there will be setting of contracts, and redundancies. The Secretary of State doesn’t see sense in having “two organisations fulfilling the same functions”. He cites a fragmented system, barriers, cultural problems and inefficiencies that constrain collective potential and prevent delivery of the best possible services for patients. His solution is to build something he describes as “genuinely new in terms of organisation, culture and performance” to deliver the Government’s forthcoming 10 Year Plan for Health.
Doubtless these announcements will be unsettling for many, and there will be a wide range of views about the process. In 2007, Kates & Galbraith opined that organisations are not ends in themselves; they are simply vehicles to accomplish strategic tasks. Nevertheless, FMLM believes every step of these changes must be carefully thought through. Clear explanations should describe how DHSC/NHSE reconfiguration will help address ongoing clinical challenges including access to GP appointments, pressure on A&E departments, and long waits for planned care.
A new team is assembling to oversee this transformation. Dr Penny Dash will replace Richard Meddings as the new chair of NHS England. Sir Jim Mackey succeeds Amanda Pritchard as NHS England Chief Executive. Prof Sir Chris Whitty was already Interim DHSC Permanent Secretary and, last week, Prof Sir Steve Powis kindly wrote to me and other members of his Medical Advisory Group confirming his intention to step down as National Medical Director this summer.
The depth and breadth of proposed changes also shine a light on the often-forgotten importance of good followership. When leaders, systems, organisations and teams change, effective followership is crucial to avoid quality improvement initiatives becoming vulnerable to interruptions and failures. Smooth transitions during times of change or succession are underpinned by capable followers well-versed in the organisation’s goals and processes. The excellent progress NHS England has achieved in areas such as mental health must not become a casualty of coming upheavals. Class-leading clinicians on the NHS England Board have already pledged to try to make the transition as smooth as possible. For the benefit of the patients we serve, it’s important clinical Leaders at all other levels strive to do the same.
FMLM would like to thank Amanda for leading NHSE from the centre for the last six years, including through the UK’s biggest public health emergency in modern history. Her 100% dedication and energy have put in place the foundations for sustainable improvement and transformation upon which the 10 Year Health Plan will build.
We would also like to pay special tribute to Sir Steve. Throughout his eight-year tenure, Steve and the clinical teams he has overseen have achieved landmark improvements in patient care. During the pandemic, Steve personally gave support and advice to NHS staff, government ministers and the wider public including appearing at over thirty Downing Street briefings. He led the development and implementation of the national cardiovascular, respiratory and stroke programmes, the creation of the first national patient safety strategy, and several national reviews, including a major assessment of transplant utilisation. Throughout all of this, Steve has remained a committed supporter of FMLM, sponsoring our National Medical Director’s Clinical Fellows Scheme, speaking at our events, and chairing the interview panel that appointed Celia Ingham Clark as FMLM’s new Chair. We are so grateful for his guidance, engagement and friendship. Steve does not intend to withdraw completely from public service. Indeed, FMLM hopes to support the recently launched review of postgraduate medical training that Steve will conduct with Prof Sir Chris Whitty.
As the next chapter of the NHS is written, FMLM looks forward to working with Dr Penny Dash, Sir Jim Mackey and Sir Steve’s successor, and to continuing to work with DHSC, the four NHS administrations, and existing professional bodies. Good leadership remains a key enabler of high-quality patient care irrespective of strategic structures.
Author
Professor Rich Withnall – Chief Executive Officer of the Faculty of Medical Leadership and Management
Prof. Rich Withnall is one of the UK’s most senior medical leaders. His career has included military service across multiple continents, advising the Government on national medical emergencies, and serving as an Honorary Surgeon to Her Late Majesty Queen Elizabeth II and King Charles III. He is the RCGP’s Chief Examiner and Medical Director for International Education & Training.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.