Intended for healthcare professionals

Observations Health Policy

Emerging tensions will affect how the NHS uses its new money

BMJ 2020; 368 doi: (Published 28 February 2020) Cite this as: BMJ 2020;368:m767
  1. Andy Cowper, editor
  1. Health Policy Insight, London, UK
  1. andycowper{at}

Power play and lack of appetite for reform are getting in the way of delivery

The fallout from former health secretary Andrew Lansley’s 2012 reorganisation of the NHS in England is still being felt. The enduring effects have largely been seen in a series of unintended consequences. The resulting uncertainty has introduced dynamic tensions into NHS and health department power structures that will play out for staff across the service as new money starts to come into the system from April.

Lansley’s key aims of an NHS driven by clinical commissioning, patient choice, and provider competition have not been realised at the front line. And the government even intends to replace or repeal major parts of Lansley’s plans, so that the NHS works better as a cooperative system.1

The independent status of NHS England was an intentional result of the Health and Social Care Act that underpinned Lansley’s reforms. But that independent status is now seen as a problem by the prime minister’s chief adviser, Dominic Cummings, and its continuation might not be guaranteed.

Cummings briefed the Times’s reliable Whitehall editor, Chris Smyth, that Number 10 planned to curb the legal independence of NHS England. “Cummings … believes that at present the law gives Sir Simon Stevens, the head of NHS …

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