WHEN Matt Hancock said last week that his proposed NHS restructure would “reduce bureaucracy and improve accountability via the fulcrum of integrated care systems”, I guess he meant he wanted to undo the mess caused by previous Conservative attempts to reorganise the NHS in 2010.

Lord Andrew Lansley’s Health and Social Care Act of 2012 has been a millstone that even David Cameron regretted not ditching more than six years ago.

The idea of making permanent some of the many improvements in the way the NHS works that have emerged during the pandemic, such as different organisations in the health service working better together, has a rationale. However, there is no reason why this could not happen more often anyway without reorganisation. It does not break any rules.

Many in the NHS believe the Prime Minister and his minister have ulterior motives in using the challenge the health service faces as an excuse to gain more direct control. The service does provide a never ending set of problems for ministers – shortages of staff and equipment, waiting lists, scandals, requests for more money! So why take it on?

The creation of 42 Integrated Care Systems, one for each region, may provide a partial answer. The new ICSs will not have to put out tender contracts for care “automatically” (so they can do so, with permission) but could be able to (or made to) contract providers working for-profit for other services. Privatisation? Let’s see.

However, if the reforms do help to end the fragmentation of NHS care we can all rejoice. But Hancock should remember that any centralisation of power brings with it centralisation of blame. Something he can deflect at the moment.

D Duell, Durham.