NHS England chief Amanda Protecard held meetings on Monday with Health Secretary Wes Streeting to find out the performance and challenges. But the last Monday was different. After discussing the condition of healthcare, she announced that she was stepping down – with just one month notice.

It came as a blow for many people in the organization, under which there are 1.4 million employees who deal with 1.7 million patients every day. But those people knew that something was happening – although not the time.

The meeting between Priichard and Streeting was the natural conclusion of changes that were rubbing in the corridors of power for some time.

NHS England was given autonomy in 2013 by the then-Rudhiist Health Secretary Andrew Lamle. Its purpose was to free the organization from intervention by politicians.

Under Sir Simon Stevens – Now Lord Stevens – NHS England developed like a rival Shakti Aadhaar and under the leadership of an alternative health secretary. He was in the heart of attracting long -term NHS plans under David Cameron and Theresa May. Lord Stevens knew his way around the Whitehall and knew how to win the battle of Backerroom with the ministers.

Amanda was the Deputy Deputy Chairman of Lord Stevens since the Protecchar 2019 and played an important role for the epidemic in the NHS response, including the vaccine roll-out. It seemed that she would take a top job in 2021. But last year, with the arrival of a labor government, certainty began to weaken.

The first clue is that things would be going back to a more traditional management rule, with more direct government control, when two health experts were appointed from previous labor governments: Allen Milburn, Blair’s Health Secretary, and Paul Korigan, a advisory. It became clear that they would be involved in shaping the policy with Wes Streeting.

A well -laid health source stated that those two “old days recalled”, before a change in the autonomy of NHS, made the system “very bureaucratic”.

Another clue came when work on a new NHS 10-year plan for England began. Lord Stevens organized a “pen” with the previous plans, but this time the government brought to the King’s Fund Think Tank in Sally Warren – NHS out of England management – to pursue work.

At the same time, the NHS was being made noise about reducing England management – and instead withdraw money for local health boards and patient services. Government sources deny that NHS England is being included in the Health Department, but says it will have a “lean” role, which will cut the repetition.

Amanda was well aware of the direction of the journey. She could see that her job was about to change and considered stepping at the end of this year. There is no suggestion of any line or conflict with Wes Streeting.

NHS officials say it was the decision to leave in late March as it would be an end of a financial year – and there was no need to stay for the launch of the 10 -year -old plan in the early summer.

In January, Ms. Protechar had an experience with two parliamentary selected committees. One suggested that he and the colleague were “Shaleen” and the other said that he was disappointed with “long and spreading answers”. In an interview by the BBC, he admitted that “We are not all magnificent artists in the committee hearing” but it was correct to investigate it. Personally, according to sources, he was “disappointing, given the process” disappointment “, seeing how much time he gave under some of the most difficult years in the history of NHS.

He will be replaced by an experienced NHS Trust Boss Boss Sir Jim McKay, which is being given the title “Infection” Chief Executive Officer. The policy will be run by the Department of Wes Streeting with Sir Jim, we have been told, focusing on delivery, including cuts in the waiting list of about 7.5 million hospitals. He had recently helped prepare a recovery scheme for employed treatment and appointments.

So where does NHS leave?

On the one hand, the Amanda Pitchard has provided consistent leadership in various roles under six separate health secretaries. The autonomy of NHS England enabled its chief executive to beat the drum for healthcare and pressurize the government.

But on the other hand, serious problems persist with the patient’s consequences and people coming close to streeting argue that more direct government control means less bureaucracy, and the ability to free resources to deploy where there is a need.

A health source argued that the upcoming change would end confusion on policy and strategy and encourage cooperation between ministers and NHS England – without formal acquisition. But another suggested that it was “a bit of a mess” and now the NHS may be volatile and distracted when they need to focus on wider health challenges.

A lot will depend on how much money is allocated in the review of Treasury expenses.

This patient matters – and it is not yet clear whether these changes will help them or not.