How Amanda Pritchard’s departure signals a new dawn for the NHS

Today, Amanda Pritchard resigned as Chief Executive of NHS England after three and a half years in charge.

Her resignation comes at an extremely challenging time for the health service with the recent Operational Planning Guidance, published at the end of January, asking NHS organisations to reduce their outgoing costs and achieve 4% productivity gains over the year.

While Pritchard’s resignation letter suggests she left of her own volition, she had been under increasing scrutiny, shown during her most recent appearance in front of the Health and Social Care Select Committee where members accused her of lacking drive and ambition.

This change delivers a fresh start for the NHS and suggests a shifting power dynamic towards the Department of Health and Social Care. This is evident from the Government’s preferred candidate as NHS England’s new Chair, widely expected to be former McKinsey & Co partner Penny Dash, and the new interim CEO Sir Jim Mackey. This duo has significant experience in the NHS and will be unafraid of calling out inadequacies in the system, as evidenced by Penny Dash’s recent scathing report into the effectiveness of the Care Quality Commission.

Health Secretary Wes Streeting has said these new appointments will require “a new relationship” between DHSC and NHS England to enhance the “one team culture”. While NHS leadership may be hoping for a joint enterprise, the evidence suggests that DHSC is very much calling the shots and will be in total control over the 10 Year Health Plan, due to be published in the coming months.

So, who’s in charge of the 10 Year Plan?

Despite Amanda Pritchard featuring front and centre in the launch of the consultation, it is certainly not NHS England.

Those advising on the strategic direction of the plan are more PwC than ICB, with a wealth of former consultants advising Streeting in DHSC, such as Alan Milburn, the Blair-era Health Secretary who spent more than a decade working in the private sector. He has been dubbed the second Secretary of State and has been instrumental in shaping the future of health policy since his return to Government. Streeting has also relied on left-leaning think tanks, scooping up Tom Kibasi, former director of the Institute for Public Policy Research to draft the plan.

While the Health Secretary clearly appreciates the role of NHS England in delivering his ambitious plans, long-term reform of the NHS is his single biggest priority in Government, and his desire for success has necessitated whittling down its influence.

Almost eight months after the General Election, Streeting’s influence continues to grow. Ahead of this year’s Spring financial forecast and comprehensive spending review, funding for DHSC is expected to remain strong compared to other departments. This vote of confidence is reflective of Streeting’s standing with Keir Starmer and Rachel Reeves but is also dependent on an expectation to deliver on his lofty aims for NHS reform.

Until now, Streeting’s plans have been clear cut: end workforce strikes, expose the state of the health service through the Darzi review, announce the 10-Year Plan, and deliver two million extra NHS appointments. The departure of Amanda Pritchard demonstrates a shift from quick wins to a long-term focus.

The Health Secretary has the influence and political capital to implement his long-term plan. His hope for the future is that he can claim accountability for its successes rather than suffer the same fate as many of his failing predecessors.