The Rt Hon
Wes Streeting MP
Secretary of State for Health and Social Care
House of Commons
London
SW1A 0AA
Tuesday, 09 September 2025
Subject: A Blueprint for Genuine NHS Transformation: Cutting Through the Noise with 10 Essential Integrations
Dear Mr Streeting,
I am writing to express my profound concern regarding the recent focus on institutional league tables, exemplified by the Queen Elizabeth Hospital, King’s Lynn, being placed at the bottom of such a ranking. While the intention to drive improvement is understood, these public rankings serve more to demoralise staff and mislead the public than to foster genuine, systemic change. This is particularly true for trusts in under-resourced and historically underfunded regions, which are grappling with the legacy of over a decade of constrained investment.
The challenge you will face is not a lack of well-documented vision; the NHS Long Term Plan itself provides a robust blueprint. The principal barrier to its realisation is a powerful ecosystem of entrenched self-interest: NHS trusts guarding their operational sovereignty, large consultancies selling costly, short-term solutions, and legacy PFI contracts that continue to leach vital resources from frontline services. This is compounded by a political cycle that often prioritises short-term announcements over the strategic, long-term change the service desperately needs.
The path to a sustainable NHS lies in the courageous pursuit of large-scale integration, designed explicitly to break these vested interests. Your fundamental challenge is to create the necessary political cover and consensus to make this happen. Getting rid of NHS England was a good start.
However, I would remind you that there are critical clinical and operational integrations that must form the cornerstone of a transformative health policy. This is cannot merely be an efficiency drive; but a fundamental rewiring of the system to place patient outcomes before organisational boundaries, and make sure that the Tories and REFORM can never privatise the NHS.
1. Back Office Functions. We must end the scandal of duplicated HR, Finance, and IT across every trust. Mandating shared regional service hubs would generate colossal savings, which must be legally ring-fenced for reinvestment directly into frontline care.
2. Diagnostic Services. The siloed inefficiency in radiology and pathology must stop. The creation of regional diagnostic networks, with central hubs providing 24/7 expert reporting and local spokes handling routine work, would guarantee faster results and uniformly high standards.
3. Specialist Tertiary Care. Expertise cannot be compromised. We must consolidate complex services like major trauma, stroke, and cardiac surgery into fewer, high-volume centres of excellence. The clinical evidence is undeniable: concentrated volume saves lives.
4. Mental & Physical Health. The artificial divide between mental and physical health must be terminated. Embedding mental health specialists within GP surgeries and chronic disease clinics will ensure we treat the whole person, not just half of them.
5. Pharmacy. A connected pharmacy system is essential. Implementing a shared medicines record and integrated pharmacy teams across hospital, GP, and community settings will drastically cut errors, reduce waste, and free up millions of hours of clinical time.
6. Urgent & Emergency Care. The public faces a confusing maze. We must simplify this into a single front door: an enhanced NHS 111 service with the clinical backing and authority to book appointments across the entire system, preventing A&E from remaining the default for those who are confused or unable to navigate the complexity.
7. Maternity Services. Services should be organised into clear operational networks. Low-risk care should be delivered in midwife-led units, with high-risk care centralised in units with specialist doctors and Neonatal Intensive Care (NICU) on site. This model is safer, clearer, and more efficient.
8. Chronic Disease Management. We must shift from reactive episodes to proactive, preventative care. This requires funding multi-disciplinary teams—comprising GPs, nurses, and specialist consultants—to manage conditions like diabetes and COPD in the community, thereby preventing acute crises.
9. Elective Surgery Hubs. Planned surgery must be divorced from the disruption of emergency care. Protected "cold sites" dedicated to procedures like hips, knees, and cataracts will obliterate waiting lists and put an end to the heartbreak of last-minute cancellations.
10. Health and Social Care. This is the final frontier and requires immense political courage. It necessitates pooled budgets, single assessments, and joint care teams under a common purpose. It is the only way to end the scandal of bed-blocking and serve our ageing population with the dignity they deserve.
The opposition to such integration will be fierce from those who profit from the status quo. It will require a Secretary of State who is prepared to look beyond the news cycle and invest political capital in a legacy of genuine reform.
urge you to be the minister who finally delivers the integration that has been talked about for decades. The blueprint is there. It now requires your leadership to implement it.
Yours sincerely,
Richard J Hannah
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