NHS England -Baas Amanda Pritchard’s sudden exit shows how power changes in health care

Amanda Pritchard, head of NHS England, would regularly have Monday meetings with health secretary Wes Streeting to revise the performance and take on challenges. But last Monday was different. After discussing the state of health care, she announced that she was resigning – with only one month of comment.

For many in the organization it came as a shock, with 1.4 million employees every day with 1.7 million patients. But those who were aware had suspected that something happened – although not the timing.

That meeting between Pritchard and Streeting was the natural conclusion of changes that had been rumbling in the corridors of power for some time.

NHS England received autonomy through the then conservative health secretary Andrew Lansley in 2013. The aim was to free the organization from interference by politicians.

Under Sir Simon Stevens – now Lord Stevens – NHS England developed what looked like a rival power base and led by an alternative health secretary. He was the core of the work on the preparation of NHS plans in the long term under David Cameron and Theresa May. Lord Stevens knew his way around Whitehall and knew how he could win back room battles with ministers.

Amanda Pritchard has been deputy for Lord Stevens since 2019 and played a crucial role in the NHS response to the pandemic, including the vaccine roll. It seemed inevitable that she would take over the top job in 2021. Understandably, she expected to stay in the same spirit as her predecessor. But with the arrival of a Labor government last year, the certainty began to weaken.

The first indication that things would go back to a more traditional management regime, with more direct government control, when two health experts were appointed from previous labor governments: Alan Milburn, Blair’s health secretary, and Paul Corrigan, an adviser. It became clear that they would be involved in shaping policy with Wes Streeting.

A well -placed health source said those two “remembered the old days”, before the shift from the NHS to autonomy, which they felt made the system “too bureaucratic”.

Another indication came when the work started on a new NHS 10-year plan for England. With previous plans, Lord Stevens had “held the pen”, but this time the government brought in Sally Warren from the king’s think tank – outside the management of NHS England – to lead the work.

At the same time, sounds were made about slimming the management of NHS England – and to transfer money to local health councils and patient services instead. Government sources deny that NHS England is housed in the health department, but say that it will have a “slimmer” role, which eliminates duplication.

Amanda Pritchard was well aware of the direction of traveling. She saw that her job would change and had considered resigning later this year. There has been no suggestion for a row or confrontation with Wes Streeting.

NHS officials say that the decision to leave at the end of March was because it will be the end of a financial year -and it was not necessary to stay for the launch of the 10 -year plan in the early summer.

In January, Mrs. Pritchard had a bruising experience through two parliamentary select committees. One suggested that she and colleagues were “complacent” and another said they were disappointed about “long and diffuse answers”. In a BBC interview she admitted that “we are not all brilliant artists at the committee’s hearings”, but it was good to be investigated. According to sources, she found the process “frustrating how much time she had given the role” under some of the most difficult years in the history of the NHS.

She will be replaced by Sir Jim Mackey, an experienced NHS Trust -Baas, who has the title the “Transition” Chief Executive. The policy is run by the department of Wes Streeting with Sir Jim, we have been told, aimed at delivery, including cutting the hospital waiting list of almost 7.5 million. He recently helped in drawing up a recovery plan for planned treatment and appointments.

So where does this all leave the NHS?

On the one hand, Amanda Pritchard has offered consistent leadership in different roles among six different health secretaries. The autonomy of NHS England enabled her Chief Executive to hit the drum for the health service and put pressure on the government.

But on the other hand, serious problems with the patient results and those who are closer to streeting remain that more direct government control means less bureaucracy and the ability to free up resources to implement where necessary.

One health source argued that the coming changes would put an end to the confusion about policy and strategy and encourage cooperation between ministers and NHS England – without being a formal takeover. But another suggested that it was “a bit of a mess” and there could now be instability and distractions for NHS managers when they have to concentrate on wider health problems.

Much will depend on how much money is allocated in the Treasury Expensable Review.

They are patients who matter – and it is not yet clear whether or not these changes will help them.