Peter Moore: Saying goodbye to NHS England

When I sat my finals fifty years ago, the examiners must have run out of questions.

They asked about the latest major NHS reorganisation. I had no idea but still passed. This taught me an important lesson I’ve remembered throughout my career. It is possible, or perhaps desirable, to work effectively in the NHS without having a clue how it works.

Sadly, it was not the last reorganisation. Over the last fifty years I have had to cope with the hospital management board, the executive committee, the Regional Health Authority (RHC), Devon Health Authority, the Area Health Authority (AHA), and the District Health Authority (DHA). In general practice we had the Family Practitioner Committee (FPC), the Family Health Service Authority (FHSA), the Primary Care Group (PCG), the Primary Care Trust (PCT) and the Clinical Commissioning Group (CCG). There are enough acronyms to win a game of Scrabble. I apologise to the numerous important committees I have missed out.

I have a confession. I retired as a GP partner just before the latest changes were implemented. These “latest changes” are the ones which are about to be abolished. Although I carried on doing locums and advisory work for the police, I was not on the front line. I developed a vague idea of the bureaucracy but never really got to grips with the details.

When I was a GP partner, I quite enjoyed the numerous reorganisations. It meant that all the managers were so busy spending their time discussing who should sit on which committee and their role that they did not hassle me with yet more bits of paper. I could get on with my job of seeing patients without having to argue why another bright idea would not work.

The NHS is now facing another major change, the largest since the last one. In the days of the Coalition Government (remember them?), NHS England was created. The idea was that NHS England was to run the NHS at arm’s length. Perhaps a little naively, it was believed that this would take the NHS out of politics.

In theory, when things went wrong, the minister could stand up in the House of Commons and say, “It’s nothing to do with me.” As the government held the purse strings, NHS England could argue that any problem was due to a lack of funding. Taking politics out of the NHS is as realistic as taking religion out of a church service.

Another problem was the line of command. What was the responsibility of NHS England, and what was the responsibility of the local trusts? Work was duplicated across the NHS.

Now NHS England is to be abolished with the possible loss of 9,000 jobs. The work will either go down to local teams or to the Department of Health.

We have to wait and see how this will work out. I would love to give an easy answer about how the massive juggernaut of the NHS should be run, but there is a reason why there have been so many reorganisations. If any had been highly effective, there would have been no more changes.

I still believe that a state-run system free at the point of need should be the most effective system. The people with the worst health are often the poorest, who are least able to afford a private system. Can the country still afford such a comprehensive system? Whenever the system, we will need to pay for healthcare. If I pay £1000 extra tax or £1000 insurance premium, I am still paying for healthcare.

As we all get older and healthcare becomes more expensive, the costs will rise. Modern medicine is a victim of its own success. It was cheaper when people died young of a heart attack. Today people with heart disease may have a stent or bypass graft. With medication they live for years. This is far more expensive, but no one is complaining.

It will take time for the new NHS changes to take effect. It is reassuring to know that they will be the last major NHS reorganisation until the next one.