Without dramatic change in management and structure, the NHS will lose support of the British electorate

Senior business executives should be appointed to run the Department of Health and Social Care and radically reshape the NHS, with more local decision-making and fewer big hospitals, a former health minister has said.

Lord Warner, a health minister under Tony Blair, has written a pamphlet for the Social Market Foundation (SMF) warning that without dramatic change in management and structure, the NHS will inevitably lose the support of the British electorate.

Norman Warner is one of Britain’s most experienced health policy leaders. A crossbench peer, he has been a senior civil servant, a health minister, a local authority chief executive and a member of the Dilnot Commission on social care reform.

His latest SMF paper warns that the NHS in its current form is under “existential threat” from the rising demands of an older population, staff retention and recruitment problems, the legacy of COVID-19 and growing public dissatisfaction.

Whoever is in government after the next election must launch a significant overhaul of health policy and management to arrest the decline of the NHS, Warner writes. Reform should start not with the NHS itself but with the Department of Health and Social Care. The department needs a “more businesslike approach” to health policy, he says.

“Improving the performance of the NHS requires us to change the culture and approach of DHSC rather than keep reorganising the NHS,” Warner writes.

“Unless there is a major injection of business and managerial thinking and action at the top of DHSC problems and failings in the health and care sector will go on being repeated year after year.”

Instead of being run by a Civil Service permanent secretary, the DHSC should led by a CEO recruited from business and paid enough to attract a senior leader from the private sector, the paper argues.

Any minister who wants to deliver health care fit for the 21^st Century should start by transforming the health department, Warner says. He also recommends the creation of an Office of Public Health, tasked with the responsibility of reducing demands on the NHS (See notes).

“A more businesslike approach is required if the NHS is to have a chance of surviving. It requires a mindset change and different types of people and structures at the top of DHSC if ministers are to have a chance of driving change successfully.”

With the DHSC properly run, ministers would be able to drive through a programme of devolving control over many aspects of healthcare to local communities and areas, Warner writes. He also argues for a long-term transfer of health resources away from big acute hospitals and towards primary and community care.