The sudden exit of the boss of England of NHS Amanda Pritchard shows how power moves in health care

Amanda Pritchard, head of NHS England, would have regular meetings on Monday with the health secretary Wes Street to examine performance and take up challenges. But last Monday was different. After discussing the state of the health service, she announced that she is resigning – with one month’s notice.

This was a shock for many of the organization, under which there are 1.4 million staff members who deal with 1.7 million patients every day. But those who have suspected that something was happening – but not timing.

This meeting between Pritchard and Streetting was the natural conclusion of changes that have been rumbling for some time in the corridors of power.

The NHS in England was autonomous by the Secretary of Health then Conservative Andrew Lansley in 2013. The objective was to release the organization of politicians’ interference.

Under Sir Simon Stevens – Now Lord Stevens – NHS, England has developed with regard to a rival power base led by an alternative health secretary. He was at the heart of work developing long -term NHS plans under David Cameron and Theresa May. Lord Stevens knew his way around Whitehall and knew how to win back battles with ministers.

Amanda Pritchard was assistant to Lord Stevens since 2019 and had played an essential role in the Pandemic’s NHS response, including the deployment of the vaccine. It seemed inevitable that she would take charge of the upper post in 2021. Of course, she expected to continue in the same vein as her predecessor. But with the arrival of a Labor government last year, this certainty began to weaken.

The first index that things would come back to a more traditional management regime, with more direct government control, came when two health experts were appointed before labor governments: Alan Milburn, Blair Health Secretary, and Paul Corrigan, advisor. It has become clear that they would be involved in the development of politics with Wes Streting.

A well -placed source of health said that these two “remembered the old weather”, before the NHS passage to autonomy, which, according to them, made the system “too bureaucratic”.

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

At the same time, noises were made on reducing NHS management in England – and the money consultation with local health councils and patient services. Government sources deny that the NHS in England is subjected to the health service, but affirms that it will have a “leaner” role, reducing duplication.

Amanda Pritchard was well aware of the trip management. She could see that her work was going to change and had planned to resign later this year. There was no suggestion of line or confrontation with Wes Streting.

NHS officials say that the decision to leave at the end of March was because it will be the end of an exercise – and it was not necessary to stay for the launch of the plan at 10 years at the start of the summer.

In January, Ms. Pritchard had deadly experience in the hands of two parliamentary selected committees. One suggested that she and her colleagues were “complacent” and another said they were disappointed with “long and diffuse responses”. In an interview with the BBC, she admitted that “we are not all brilliant performers during committee’s hearings”, but it was just to be examined. In private, according to sources, she found the process “frustrating given the time she had given to this role” in some of the most difficult years in the history of the NHS.

She will be replaced by Sir Jim MacKey, an experienced boss of the NHS Trust, who is entitled the Director General of the “Transition”. The policy will be headed by the department of Wes Streting with Sir Jim, we are told, focusing on delivery, including the reduction in the hospital’s waiting list of almost 7.5 million. He had recently helped write a recovery plan for treatment and scheduled appointments.

So where all this leaves the NHS?

On the one hand, Amanda Pritchard provided coherent leadership in various roles of six different health secretaries. The autonomy of NHS England allowed its general manager to hit the drum for the health service and to put pressure on the government.

But on the other hand, serious problems remain with the results for patients and those who are closer to street affirm that more direct government control means less bureaucracy, and the ability to release resources to deploy if necessary.

A source of health argued that future changes would confuse policy and strategy and encourage collaboration between ministers and NHS in England – without being an official takeover. But another suggested that it was “a bit of a mess” and there could now be instability and distractions for NHS administrators when they need to focus on wider health challenges.

Many will depend on the amount of money allocated in examining the treasury.

These are the patients who count – and it is not yet clear whether these changes will help them or not.