Wes Streeting's power grab: who is running the NHS?

Health Secretary Wes Streeting said there must be a "new relationship" between the Department of Health and the NHS after the abrupt departure of the chief executive of NHS England earlier this week.

Streeting has been battling for "tighter Whitehall control", as part of his "vow to fix the 'broken' NHS". He insisted he did not ask Amanda Pritchard to quit her NHS England leadership role but her replacement, James Mackey, has been given "a remit to radically reshape" how NHS England works with the Department of Health and Social Care (DHSC), said the Financial Times.

The overhaul is evidence of Streeting's "frustrations" with the system's "resistance to change", said The Telegraph. But some worried NHS England staff see the ousting of their leader – and the signalled "significant" job cuts to come – as a "a power grab", said The Guardian.

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What did the commentators say?

Streeting and Pritchard have "gone to great pains" to paint her departure as "amicable" but the "wider context" of her resignation "cannot be ignored", said an editorial in The Times. The government has "spoken loftily of its plans to end inefficiencies and waste" in the NHS, and must believe a "major structural shake-up" that brings NHS England "back under ministerial control" will give it the power to make the "radical change" it has pledged.

Pritchard's position became "quite untenable" after "attacks by two parliamentary committees on her performance", and Streeting will hope her successor can help deliver the NHS reforms needed to "help win the next election", said Sean O’Grady in The Independent.

As part of Streeting's move to "gain and assert much more control", the first focus will likely be on "shrinking the size" of NHS England, the body that's "in operational charge of the health service", through "deep cuts to its 13,000-strong workforce", said Denis Campbell in The Guardian.

The health secretary will "end the situation" in which officials at the DHSC and NHS England "cover the same area of health policy". This "unnecessary duplication of roles" has led to "disagreements" that sometimes "held up key policy initiatives", a Whitehall source told The Guardian.

Streeting has already "removed" NHS England's Conservative-appointed chair, Richard Meddings, and replaced him with Dr Penny Dash, a "no-nonsense character" who shares Streeting's "zeal to radically reform the NHS".

And the health secretary has also made it clear that those in charge of failing NHS hospitals will be "sacked and blocked from taking another job in the sector", said Dr Emma Jones at UnHerd. So far, though, there has been "no evidence of this actually happening". There is still a "jumbled approach to who really matters" in the NHS. "Incompetent managers" should "face the same consequences as incompetent doctors", and the health service "urgently needs a total overhaul of management recruitment".

What next?

New leadership at NHS England is an "opportunity for a reset" and, hopefully, one that will "stand the test of time", said The Times. Mackey is likely to oversee a "drive" towards a "leaner" organisation that will hand "more autonomy" to "local health providers".

But the government will still have to grapple with the "high demand and budget pressures" in the health service, said the FT. It is "an extremely critical time for the NHS", so it is "crucial" that the DHSC and NHS England "work well together", and "NHS leaders retain operational and clinical independence for the day-to-day running of the service", Sarah Woolnough, chief executive of health think-tank The King’s Fund, told the paper.