Boris Johnson’s government has for the first time confirmed the existence of a prime ministerial task force which is reportedly planning a “radical shake-up of the NHS”.
Freedom of Information disclosures to openDemocracy show the new “No.10 Health and Social Care Taskforce” reports to a Steering Group chaired by Munira Mirza, the influential head of Boris Johnson’s policy unit, and that it “met weekly” from July to September with a further meeting in October.
Mirza, a political appointee who previously worked for Johnson when he was London mayor, has no background or policy experience in health.
The disclosures also reveal that whilst some Department of Health officials do attend the task force, it is led by four senior civil servants based at the Treasury, and none of whom are from the Department of Health.
The government has not published any information about the task force’s existence, work, terms of reference or membership – and has refused to answer questions about the nature of its work.
However in July, The Guardian reported that Boris Johnson was planning a “radical and politically risky reorganisation of the NHS” – in response to “frustration” with the NHS’s performance during the COVID crisis.
And in September, the Financial Times reported that inside sources had revealed an interdepartmental health task force with a wide remit, “determining what the health service’s goals should be”.
The government has previously claimed that rumours regarding the work of the task force are “pure speculation,” and did not even formally confirm its existence, insisting that instead: “As has been the case throughout the pandemic, our focus is on protecting the public, controlling the spread of the virus, and saving lives.”
Not only is the group now confirmed to exist, but Mirza’s leading role and the lack of leaders from the Department of Health suggest that its work is politically focused.
Jackie Applebee, Chair of Doctors in Unite, told openDemocracy, “It is shocking that people with no background in health are meeting regularly to determine the future of health and social care. COVID-19 has surely shown us that putting people with no health experience in charge of the NHS is a disaster.”
Meanwhile Tamasin Cave, a lobbying expert, has called Mirza “a political hire who is unqualified to mess around with the NHS”. She also questioned the timing: “Why are they doing this now, given how much the NHS – and the country – has on its plate already?”
The revelations come as concerns are mounting about post-COVID pressures on the NHS.
Kailash Chand, former deputy chair of the British Medical Association, told openDemocracy. “The waiting lists have built up to an awful level, and they’ll use that as an excuse to bring the private sector in, as they did under the previous Labour government.”
He described Boris Johnson as “dangerous” and having “no faith in public services.”
Secrecy ‘the worst possible way’ to do NHS reform
In their Freedom of Information responses, the Department of Health, the Treasury and Number 10 have all denied having a full record of who has been attending the task force and steering group meetings.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, has criticised the government’s secretive approach as “the worst possible way to design a major reform.”
“Secrecy encourages groupthink. The government rightly stresses the importance of public and patient involvement and co-production with users when designing new models of care. It is bizarre to reject these ideas for the really big decisions.”
What today’s disclosures do show is that the task force’s civil service policy lead is Adrian Masters. An alumnus of the management consultancy McKinsey, Masters played a key role in shaping the last major piece of NHS legislation, the 2012 Health and Social Care Act.
McKinsey was reported to have drafted large parts of that bill, which was criticised as enabling increased fragmentation and private sector outsourcing of large parts of the NHS.
The task force also includes William Warr: Johnson’s health advisor and a former lobbyist at the firm of Lynton Crosby, who masterminded numerous Conservative Party election campaigns and Johnson’s successful 2008 London mayoral bid.
Warr described the NHS as “outdated” in a Telegraph article penned shortly before he and Johnson entered Downing Street last year, suggesting that the incoming prime minister should ask himself: “If I created the NHS today from scratch, what would it look like?” Warr answered: “Nothing like the monolith we have today.”
Boris Johnson’s first Queen’s Speech in December last year promised to "bring forward detailed proposals" and "draft legislation" to "accelerate the Long Term Plan for the NHS, transforming patient care and future-proofing our NHS."
The British Medical Association (BMA) has characterised this Long Term Plan as a “plan for a market-driven healthcare system”.
Kailash Chand, the former BMA deputy chair, told openDemocracy he believed the purpose of the task force was part of a wider effort to drive forward more NHS privatisation: “These people are really clever at bringing these things in disguise. This is essentially about getting us towards... big pickings for private companies. It’s not going to happen overnight but this is the road map.”
Referring to McKinsey's regular NHS recommendations that were implemented under the Cameron government, he said: “McKinsey were brought in previously to recommend financial savings. The easiest way for hospitals to achieve those targets was to cut beds, cut nurses and the salary bill. And we’re still suffering today.”
Boris Johnson has faced criticism for appointing political allies with no health experience to key roles in the COVID-19 response. Test and Trace head Dido Harding, another former McKinsey employee and Tory peer, is in the process of taking over a large portion of the soon-to-be-abolished Public Health England’s remit, the government announced in August. She has also been tipped as favourite to take over as chief executive of the English NHS from the current incumbent, Simon Stevens, next year.
Stevens’ own proposals for major NHS reform last year attempted to allay fears about further privatisation, though campaigners raised concerns that they could make outsourcing less transparent.
Both the Department of Health and the NHS now appear to be taking a back seat in policymaking. Stevens is not on the task force, and none of the four top senior servants in charge comes from the department.
openDemocracy approached Munira Mirza, Adrian Masters, Number 10 and the Treasury for comment, but all have declined to respond by the time of publication.