Thread by @HarryAEvans

I promised a thread on new NHS tech "quango" @NHSX. I'm NOT going to assess here whether it's a good thing and instead explain the significance of this shift historically.

So the first thing to say is that the creation of quangos in response to particular issues is not new. But most often they are created from integration/disintegration of existing ones.

In the case of @NHSX it looks to siphon off bits of NHS England - including staff and responsibilities, who currently have responsibilities over delivering technological transformation.

Ah. You might ask the question: why is a digitally savvy secretary of state able to siphon off parts of NHS England into a different ALB just because he has an interest in it? Doesn't that call into question the political independence of NHSE?

It's a fair question. I think @nicholastimmins shows that in reality the political independence of NHSE is quite flimsy, but can be maintained if you have a fairly compliant secretary of state (like Jeremy Hunt?) instituteforgovernment.org.uk/sites/default/…

So... what recourse does a less compliant secretary of state have to mixing things up a bit? There's putting something through parliament of course... though that feels unlikely at the moment.

So what can you do...? You'll find out after this short break (as I have my hair cut... sorry.)

Aaaaand we're back. So what could Secretary of State do to form @NHSX? You could create a special health authority - like @NHSBT. That would provide a way of installing a body without need for primary legislation. So does that fit the bill?

Well, it doesn't look like that's what @NHSX is. I think there are restrictions around the powers available to special health authorities... Though admittedly we are DEEP in the source code of government here, which is not my area.

The press release doesn't give much away on this - and it seems like known terminology is being avoided. This is billed as a 'joint organisation' between NHSE/I and DHSC. So maybe NHSE have voluntarily derogated some of their powers to a no-man's land between them and DHSC?

I've got to admit - it's not entirely clear (can @krfarrington shed any light?). But what is clear is that this is quite a radical departure from what's gone before. We have a new body that has been set up by SoS, and powers/budget are being transferred by NHSE. It's significant.

And it's significant because it demonstrates that the independence of NHSE from DHSC is only really at the pleasure of the SoS (see earlier in this thread). It's also significant because Matt Hancock is in his nature a disruptor.

In another @nicholastimmins classic, Victoria Bottomley describes a cycle of health secretaries who break windows, followed by those who seal them back up again - window breakers and glaziers health.org.uk/publications/g…

Andrew Lansley was a classic window breaker - see H&SC Act. And Jeremy Hunt spent a lot of time repairing the windows. Now we have a self-described disruptor in Matt Hancock.

And @NHSX is one example of breaking the windows: finding workarounds to existing legislation that exists to guarantee the independence of NHSE from DHSC.

I won't be so melodramatic as to say this represents the end of NHSE's independence... far too premature. But if this is all it takes to take powers from NHSE, then we might see Matt Hancock breaking some more windows. End of thread!