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‘The World’s Biggest Quango’: The first five years of NHS England

The creation of NHS England has failed to take the politics out of healthcare provision in England.

NHS hospital sign

The creation of NHS England has failed to take the politics out of healthcare provision in England, argues this report.

NHS England – dubbed “the world’s biggest quango” by the then Shadow Secretary of State for Health, Andy Burnham – was established five years ago by the Health and Social Care Act 2012 as a statutorily independent board, aiming to end “political interference in the NHS”. Yet, the report argues, the current Secretary of State, Jeremy Hunt, has been as closely involved in the details of NHS performance and planning than his predecessors.

Nor has its creation led to the NHS being run on “quasi-market” lines as its principal architect, Andrew Lansley, intended. Instead – despite the fears of critics – the Act turned out to be the high-water mark of faith in choice and competition. It has been followed by a return to a more managed system, with the 'balkanised' bodies it created being slowly but surely brought together and merged.

'The World’s Biggest Quango' draws on extensive interviews, many of them exclusive, with some of those most intimately involved in the first five years of NHS England. The author reveals how personality continues to play an important role, with Health Secretary Jeremy Hunt and NHS England Chief Executive Simon Stevens both having very different styles to their predecessors.

One area of successful reform, according to the report, is in giving the NHS its own genuinely independent voice, essentially for the first time. Jeremy Hunt says this is “the one thing I would not have done differently” had he been legislating. The report concludes, however, that moves to create a more unified board at the top of the NHS and more integrated services locally mean that at some point fresh legislation will be needed.

This report was produced by the Institute for Government and The King’s Fund.

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