This was the Secretary of State for Health and Social Care’s first question session with the Select Committee that covers his department since he announced plans for new health legislation, the abolition of NHS England and cuts to ICB staffing budgets.
Sir Jim Mackey, Transformation CEO of NHS England and Sir Chris Whitty, Interim DHSC Permanent Secretary also took questions.
A full transcript is available here.
Among the Health and Social Care Select Committee members asking questions were Ben Coleman (Lab, Chelsea and Fulham) and Danny Beales (Lab, Uxbridge and South Ruislip), both of whom LMC representatives have met with recently in their capacity as constituency MPs.
NHS England abolition and ICB cuts
Layla Moran MP (Lib Dem, Oxford West and Abingdon) the committee chair asked what Mr Streeting was hoping to deliver with the reforms. He said his two main aims were to remove a large amount of duplication of functions and to devolve more power to a local level so there is less command and control from the centre, which impedes the NHS’ ability to meet the diverse needs of the population.
When pressed on whether he was deciding form before knowing function by announcing the reforms before the NHS 10 Year Plan was published, Mr Streeting said he already knows the overall direction he wanted the NHS to take with more local decision making and a greater focus on prevention.
On ICB staffing cuts: Sir Jim Mackey will be reviewing the submissions from each ICB to make sure they’re not suggesting cutting staff who will be key to delivering parts of the 10 Year Plan.
Pressed on timelines by Ben Coleman, Mr Streeting only committed to passing the legislation required to abolish NHS England within two years.
Mr Coleman went on to ask about local flexibility and whether there would be a single top-down model imposed or a limited number of models permitted for Mr Streeting’s plans to move more care into the community.
Mr Streeting responded:
“It is important that we give communities and system leaders the freedom and flexibility to do the kind of place-based planning and delivery of services that the Chair was referring to. We will take a test-and-learn approach and give more freedom, more flexibility and more powers to the frontline. We will be judging them on outcomes. Is access improving? Is quality improving? Are outcomes improving? Are we reducing health inequalities in our country at the same time? Those are the key tests.”
Asked by Alex McIntyre MP (Lab, Gloucester) what specifically was duplicated between NHS England and the DHSC, Mr Streeting pointed to HR, finance and communications departments. On his figure of a 50% reduction of head count Mr Streeting said this was a direction of travel rather than a hard and fast target.
Questioned by Joe Robertson (Con, Isle of Wight East), Sir Jim Mackey said he was looking at levelling out staff spending costs between ICBs, noting that some spent far more than others.
Sir Jim also confirmed that discussions were ongoing with the Treasury about whether they would reimburse ICB redundancy costs or if they would have to be covered from existing budgets.
Social care and clinical leadership
Danny Beales asked about the place of social care in the Government’s plans and what would happen to the clinical leadership roles currently employed by NHS England. Mr Streeting said he wanted to keep social care separate to the NHS but working closely with it and he would not rule out transferring resources from the NHS if he felt better outcomes and value for money could be achieved in social care. Mr Streeting went on to speak about the importance of clinical leadership and avoiding political interference in it,
Mental health and welfare
Mr Streeting was pressed by Layla Moran on mental health spending falling as an overall percentage of NHS spending. Mr Streeting countered that it was still rising as an overall figure. Ask about the removal of some mental health spending targets, Mr Streeting justified this as part of a wider push to subject the NHS to fewer targets and less reporting.
Ms Moran went on to ask Mr Streeting about his remarks that certain mental health conditions are over diagnosed and GPs are pressured to issue fit notes. Mr Streeting cited a GP authored paper in the BMJ or issuing fit notes and explained that he wants to see earlier interventions in patient’s wellbeing issues before they turn into mental health problems or further into mental health crises.