By Suzannah.Brecknell

19 Aug 2010

Big changes are afoot in the NHS, and a refocused Department of Health will follow. Suzannah Brecknell reports.


In the fast-changing landscape of Whitehall, the Department of Health (DH) has been a fairly stable landmark: it has been over 20 years since its last departmental reorganisation, when it lost control of social services. That could be about to change.

Before the election, secretary of state Andrew Lansley let it be known he would like to rename the DH as the Department of Public Health. Though he has made no formal announcements on names since coming to office, the reforms outlined in the NHS white paper published last month will nonetheless mean a significant change in the role and focus of the department.

If Lansley’s plans come to fruition, consortia of GPs will have control of much of the NHS budget. Patients will control their own health records and have more choice over their place of treatment, basing decisions on a range of information including the care providers’ track records of improving patients’ health. Hospitals will become foundation trusts, answerable to the independent regulator Monitor rather than the DH. The system will be overseen by an independent NHS commissioning board.

Broadly, these reforms align with the first three priorities set out in the DH draft structural reform plan (SRP): to create a “patient-led NHS”; focus resources on outcomes; and “revolutionise NHS accountability”. DH acting permanent secretary Richard Douglas summarises the remaining two priorities as: improving public health through “a new public health delivery system”; and “improving accessibility and options for long-term and social care”.

These five priorities, he tells CSW, “will lead to a refocused department, concentrating on improving public health, tackling health inequalities and reforming adult social care, while demonstrating efficiencies in management and administration costs.” Though Douglas emphasises the need for efficiency, concerns have been raised about the speed and cost of these reforms. Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, estimates that the reorganisation would cost between £2bn and £3bn to implement – figures that the DH says it does not recognise.

For DH officials, the focus on public health and reforming social care will require partnership with several other organisations, most notably local government – which will be given more powers, such as the right to challenge health organisations over service closures, and control over a ring-fenced public health budget.

The SRP also outlines plans to support councils and social care providers to become more efficient, and to “remove barriers between health and social care funding to incentivise preventative action”. Pooled budgets in any area can create complications, but aligning funding of means-tested social care and non-means-tested health care could be a particular challenge.

Douglas acknowledges that civil servants may feel unsettled, as the new policies could mean “a marked change from what we’ve done in the past”. He advises colleagues in the department: “We all need to accept that our work will change. Some things will stop and some things will be delivered in different ways. But that does not mean that what we have done in the past had no value, nor that we will not have an important role in the future.”

The ministerial team
The DH ministerial team meets every Monday, parliamentary under-secretary of state Anne Milton tells CSW, along with the health whips and secretary of state Andrew Lansley’s principal private secretary. Lansley “has a very inclusive manner and is keen that everyone has a chance to have their say,” says Milton, adding that the meetings cover “a lot of ground” from organising upcoming parliamentary and media activity to “discussing any thorny issues”.

Lansley spent seven years as shadow health secretary, and in 2008 David Cameron guaranteed him the role of health secretary if he became prime minister. A Tory strategist for many years – he ran the 1992 election campaign – he is on the left of the party.

Health minister Simon Burns served on the health committee for six years, and has been in the shadow health team twice. This long experience was, however, somewhat overshadowed in his early days as a minister when he was forced to apologise after calling Speaker John Bercow a “sanctimonious dwarf”.

The department’s Lib Dem voice comes from Paul Burstow, an MP since 1997 and a former Sutton councillor with 16 years’ experience. In Parliament, he first worked on his party’s local government team until he was appointed to the shadow cabinet in 2001, with a brief to look at older people and social services. Anne Milton and Earl Howe act as parliamentary under-secretaries of state. Milton, a Tory MP since 2005, is a former nurse. Earl Howe, an elected hereditary peer, has been opposition spokesman for health and social services in the Lords since 1997.

In the fast-changing landscape of Whitehall, the Department of Health (DH) has been a fairly stable landmark: it has been over 20 years since its last departmental reorganisation, when it lost control of social services. That could be about to change.

Before the election, secretary of state Andrew Lansley let it be known he would like to rename the DH as the Department of Public Health. Though he has made no formal announcements on names since coming to office, the reforms outlined in the NHS white paper published last month will nonetheless mean a significant change in the role and focus of the department.

If Lansley’s plans come to fruition, consortia of GPs will have control of much of the NHS budget. Patients will control their own health records and have more choice over their place of treatment, basing decisions on a range of information including the care providers’ track records of improving patients’ health. Hospitals will become foundation trusts, answerable to the independent regulator Monitor rather than the DH. The system will be overseen by an independent NHS commissioning board.

Broadly, these reforms align with the first three priorities set out in the DH draft structural reform plan (SRP): to create a “patient-led NHS”; focus resources on outcomes; and “revolutionise NHS accountability”. DH acting permanent secretary Richard Douglas summarises the remaining two priorities as: improving public health through “a new public health delivery system”; and “improving accessibility and options for long-term and social care”.

These five priorities, he tells CSW, “will lead to a refocused department, concentrating on improving public health, tackling health inequalities and reforming adult social care, while demonstrating efficiencies in management and administration costs.” Though Douglas emphasises the need for efficiency, concerns have been raised about the speed and cost of these reforms. Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, estimates that the reorganisation would cost between £2bn and £3bn to implement – figures that the DH says it does not recognise.

For DH officials, the focus on public health and reforming social care will require partnership with several other organisations, most notably local government – which will be given more powers, such as the right to challenge health organisations over service closures, and control over a ring-fenced public health budget.

The SRP also outlines plans to support councils and social care providers to become more efficient, and to “remove barriers between health and social care funding to incentivise preventative action”. Pooled budgets in any area can create complications, but aligning funding of means-tested social care and non-means-tested health care could be a particular challenge.

Douglas acknowledges that civil servants may feel unsettled, as the new policies could mean “a marked change from what we’ve done in the past”. He advises colleagues in the department: “We all need to accept that our work will change. Some things will stop and some things will be delivered in different ways. But that does not mean that what we have done in the past had no value, nor that we will not have an important role in the future.”

The ministerial team
The DH ministerial team meets every Monday, parliamentary under-secretary of state Anne Milton tells CSW, along with the health whips and secretary of state Andrew Lansley’s principal private secretary. Lansley “has a very inclusive manner and is keen that everyone has a chance to have their say,” says Milton, adding that the meetings cover “a lot of ground” from organising upcoming parliamentary and media activity to “discussing any thorny issues”.

Lansley spent seven years as shadow health secretary, and in 2008 David Cameron guaranteed him the role of health secretary if he became prime minister. A Tory strategist for many years – he ran the 1992 election campaign – he is on the left of the party.

Health minister Simon Burns served on the health committee for six years, and has been in the shadow health team twice. This long experience was, however, somewhat overshadowed in his early days as a minister when he was forced to apologise after calling Speaker John Bercow a “sanctimonious dwarf”.

The department’s Lib Dem voice comes from Paul Burstow, an MP since 1997 and a former Sutton councillor with 16 years’ experience. In Parliament, he first worked on his party’s local government team until he was appointed to the shadow cabinet in 2001, with a brief to look at older people and social services. Anne Milton and Earl Howe act as parliamentary under-secretaries of state. Milton, a Tory MP since 2005, is a former nurse. Earl Howe, an elected hereditary peer, has been opposition spokesman for health and social services in the Lords since 1997.

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