Former chair of the Health and Social Care Committee Steve Brine expressed his surprise at Labour choosing to plunge in with reorganisation in its first term. 

‘I thought it was something they would get into in the second term when they got frustrated and it wasn't just as straightforward as changing the personnel at the top of Government,' Brine said. 

The former Tory MP said the Government was pursuing an evolving health policy rather than a revolutionary one. 

‘With evolution it's okay as long as you know where you want to get to and why you want to get there and I'm not entirely sure they do,' Brine noted. 

The former committee chair said the jury was definitely out on whether this was a political master stroke. 

Brine said he would have felt more confident in the move if it had been part of the 10-Year Health Plan. 

The ex Tory MP predicted abolition would take the whole of the Parliament to deliver and would not move the dial on frontline issues. 

Labour MP and member of the Public Accounts Committee, Anna Dixon, said NHSE abolition was just another move to unravel the ‘pretty disastrous' Lansley reforms. 

‘We've got a system where there is massive duplication,' Dixon noted. 

‘When finances are tight, Wes has come in with a very clear and urgent mission to get the NHS back on track.

‘His priority is that we've got to get efficiency. We've got to cut the number of people at the centre so that we can push more out of that to the front line.' 

The Labour MP said the scale of abolition had to be kept in perspective compared with the Lansley reforms that ‘could be seen from space'. 

However, Sally Gainsbury, senior policy analyst at the Nuffield Trust, said that in terms of redundancies the moves would be at a ‘similar level' to the Lansley reforms. 

‘The different is that the Lansley reforms were about wholescale restructuring of organisations,' she added. 

Dixon said reorganisation was not about delivering outcomes but making the centre more efficient, adding the Government would be judged on its delivery of the three shifts. 

‘As a Public Accounts Committee member one of the really frustrating things looking back at the Department of Health accounts is that though there has been talk of a shift to the community and prevention, all the money has gone in the opposite direction,' she noted. 

Dixon said abolition was the result of a combination of a man on a mission as well as the need to have direct accountability. 

‘We need to make sure the structures are right to deliver the 10-Year Health Plan,' the MP argued. 

Gainsbury highlighted the ‘huge uncertainty' that NHS staff were facing with around 10,000 redundancies in the offing. 

She observed ICBs, who are themselves facing 50% cuts, will be expected to deliver on the ever higher public expectations of healthcare, adding reorganisation risked becoming a ‘huge distraction' to delivering better outcomes. 

Aidan Rave, of the Good Governance Institute and non-executive member of Buckinghamshire, Oxfordshire and Berkshire West ICB, said NHSE abolition had been a ‘fairly safe bet' from a political perspective but added there was a question of where it fits in the grand scheme of things. 

‘It feels like quite a lot of things that NHSE did will be shunted to the ICBs,' Rave said while also noting the ‘brutal' cuts organisations are being asked to make. 

The ICB board member said abolition did nothing to address the deeper societal issues about what sort of healthcare system people want. 

Rave said abolition ‘felt like a singular act that didn't fit with lots of other things we need to do'. 

‘I don't feel optimistic that NHSE abolition is suddenly going to give us space to make those conversations,' he added. 

10-Year Health Plan 

Looking ahead, Dixon said she hoped abolition would help push forward devolution to healthcare provision at a place level. 

Brine said his hope for the 10-Year Health Plan was that it ‘overwhelms' and comes with lots of new money to promote a leftward shift in direction, however, he said his fear was that the plan ‘underwhelms' and is very ‘top level'.

‘That's the big challenge for ministers to make sure it overwhelms people and sets a real path to a much wider plan to transform health services,' he added. 

Dixon cautioned the Government was unlikely to get the Plan right in its first iteration adding it would require course correction during implementation. 

The Labour MP said she hoped the Plan would give a sense ‘not just of direction but changing incentives in the system so that we get the right alignment' towards partnership working and reduced acute spending. 

Rave called for a culture change in rolling out the Plan from the mantra that the NHS could fix everything to a more considered debate that challenged the ‘sometimes egoistical dominance' of the acute hospitals. 

The ICB board member warned of a ‘reverting to type' focused on the ‘big ticket issues that dominate debate'. 

Gainsbury commented: ‘It doesn't matter whether it's underwhelming or overwhelming if the Plan is disconnected from where the money is.' 

Brine concluded the Plan will need to bend the demand curve through sickness to prevention if the NHS is to survive. 

‘My message to the secretary of state would be use your big majority and public mandate to be radical on population level intervention public health measures,' he said. 

‘Take on the nonsense of the nanny state argument. It's a publicly funded health system, we have a right and responsibility to tackle it.

‘That means getting upstream through primary prevention and looking out from the Department to the so-called health mission which is absolutely the right approach.'