Lansley, NHS organisation and data, and Covid-19

It is wholly unsurprising that local authorities do not have sufficient detailed data to understand local coronavirus prevalence, and to manage hotspots and other breakouts. 

This is at least partly an effect of Andrew Lansley’s benighted reorganisation of the English NHS in 2012, which removed significant access to detailed care data from local commissioners, and moved public health departments to local authorities, where they had even less access to key data - and were also hit by the cuts to local authorities’ budgets over the last ten years.

The Lansley act centralised a lot of key NHS and care data with a single central body, now known as NHSX.  This was in line with a narrative of centralised control of the service and a disempowerment of local bodies. 

This policy has acted as a contributory factor in the Government’s ill-fated attempt to build a ‘track and trace’ app based on a centralised data store.   It is now clear that alongside central direction and guidance, control of the pandemic requires agile local epidemiology and professional management, backed by up-to-date, detailed data, to lead local test, track and trace activities and manage change.  Much of this existed, in depth, before 2012, but has been significantly eroded since.  Despite this,  almost all the successful case tracking currently being done is down to these pre-existing local, experienced public health teams, not Hancock’s vaunted new, parallel structures.

However, what we are now witnessing, finally, is a partial U-turn of the policies of the last eight years.  Data is beginning to move.  Sadly, the paucity of timely local data in the right place will take time to fix properly, as providing it still runs counter to the centralising mindset, and the system will need to create new capacity to get it to where it properly belongs.