New NHS reforms announced today. Seems to be a story of two parts, plus a missing character. Quick thoughts (1/):

Part 1 of the story is a set of technical fixes wanted by NHS leaders to encourage collaboration in the health system. The direction here makes sense—and fits with what the NHS has been doing for ages. Competition is (mostly) out; collaboration is in: good (2/)

And the need for legal changes to tidy the mess left by Lansley’s 2012 Act has long been recognized. But... (3/)

The benefits of integration are often way overstated, and the risk of reorganizations underplayed. In its first 30 years, the NHS’s structure was relatively stable. But over the past 30, the NHS in England has been on an almost constant treadmill of reform and reorganization (4/)

Overall, evidence suggests that previous reorganizations have delivered little measurable benefit. They can also distract and disrupt, depending on how they’re done. The list of other things for the NHS to be doing during and after the pandemic is very long. So be cautious (5/)

(Plus there’s still quite a lot of detail left to be filled out about how ICSs will actually work in practice) (6/)

Part 2 of the story is a set of political changes proposed by government to increase ministerial control over the day-to-day workings of the NHS in England. The rationale here isn’t very clear (7/)

Jeremy Hunt—the last health sec—claimed he never felt he ‘lacked a power to give direction’ to the NHS when he needed to under the 2012 Act. But Matt Hancock must feel less powerful (8/)

The leaked white paper seemed to claim that the pandemic illustrated the need for these changes. But evidence that stronger ministerial control would have boosted the NHS’s pandemic performance is hard to find (9/)

The missing character—as ever—is a comprehensive plan for reforming adult social care in England. Sure, this bill is mostly about the NHS. And a plan for social care is promised (you guessed it…) later... (10/)

But we’ve been hearing that for an awfully long time now. Continued government inaction on social care amounts to choosing to prolong major public policy failure (11/)

Some more analysis with context, nuance, better word choice, etc here:

https://www.bmj.com/content/372/bmj.n248
https://www.bmj.com/content/371/bmj.m4468
https://www.prospectmagazine.co.uk/politics/does-the-nhs-need-another-reorganisation

(12/12) @HealthFdn

@nedwards_1 @HPIAndyCowper @mancunianmedic @so_says_sally @Davewwest @ADMBriggs @TimGardnerTHF etc - hopefully feels sensible