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NHSI and NHSE merger plans mark ‘profound shift’ in management – with potentially big risks

NHS England and NHS Improvement (NHSI) have announced plans to work closer together by establishing a new NHS Executive Group and an NHS Assembly, as well as aligning their current non-executive board committees – in a move that providers argue could “herald a profound shift in the way the NHS is led at national and regional level, with important implications for trusts and their leaders.”

In board papers from their first-ever joint meeting, the two organisations outlined ways they will align the two bodies in an effort to streamline quality of care for the population and efficient usage of public money.

The proposals include the creation of a new NHS Executive Group, headed by two new chief executives who will oversee all national and regional directors from the two arms of the NHS.

Three new national director roles will be created which will report to both CEOs, including an NHS medical director, nursing director/chief nursing officer for England, and a chief financial officer.

Management will also be reshaped and aligned, with NHS England and NHSI’s non-executive led board committees being adjusted, including internal management and interactions conducted at once, allowing for “clear accountabilities at national, regional and system levels.”

The board papers said: “Our guiding principle in this work is setting ourselves up to provide effective system leadership to the NHS. This will require us to be agile and adaptive, developing a learning culture that allows us to be flexible to the changing needs of the health and care system.”

While they recognise that both organisations have some distinctive and non-shareable statutory functions, and that primary legislation means they must have separate board governance, that “need not stand in the way of enhanced joint working in many areas.” Ultimately, they want to “move from a world where local health organisations sometimes receive different and conflicting messages from the national bodies” to one where their integrated regional teams have a “single conversation” with trusts and CCGs.

NHS Confederation’s boss, Niall Dickson, said this “has the hallmarks of a good move,” with his organisation’s members telling him that national messages are “often contradictory, expectations unrealistic and that far too much time and effort is spent sending information to the centre.”

“Closer working will be welcomed across the NHS as we have long called for a merger and this is real progress towards that,” added Dickson.

NHSI and NHS England also hope to take a more “holistic view” of NHS resources, better align financial incentives, and leverage their distinctive competencies to “build out capabilities where there has been a gap in national leadership.” Part of this includes mobilising national implementation resource for the upcoming NHS 10 Year Plan.

Single financial and operational planning process

Amongst the financial changes, the bodies will introduce a single financial and operational planning process for the health system alongside the new CFO to ensure effective use of national resources at areas of need.

Similarly, there will be a single performance management process and alignment of regulatory interventions, a single internal talent management process, and a single process for establishing and reviewing national strategic programmes.

The Five Year Forward View (FYFV) was also of high priority to the alignment between the two organisations. A new national assembly will be created which will allow stakeholders to discuss oversee progress on the scheme.

“In line with the vision of the NHS FYFV, we are seeing a growing movement towards commissioners and providers focusing on population health supported by local system-wide action,” the plans said. “This means working together to mobilise community assets and collective capabilities to improve quality of care for individuals, health outcomes for populations, and wise stewardship of taxpayers’ resources.”

‘Big risks’ involved

Chief executive at NHS Providers, Chris Hopson, said that some of the proposals were welcome, but claimed there were some “big risks” in the major plans to bring the two organisations together.

“This must be a genuine joint venture of two equal partners,” commented Hopson. “The single joint finance director, for example, must be committed to setting financial and operational performance requirements that providers can actually deliver. And while regional directors will be better placed to offer trusts support, there is also more potential for unwelcome interference.

“Success will depend, in large part, on following through on the commitment to devolving power to the regional directors who, in turn, must have the expertise and credibility to work well with trust leaders,” he continued. “It will also require a realistic planning, finance and performance framework, and a genuine commitment to involve frontline leaders in developing the detail of future plans.”

The CEO also argued that poor management of finances and staff resources could create “an unmanageable monolith.”

However, he did accept that the changes could “herald a profound shift in the way the NHS is led” regionally and nationally, with trusts likely embracing less duplication and better coordination between the two bodies and a single, aligned NHS leadership.

In their board papers, the two NHS organisations gave further information on plans to implement an integrated regional model that was announced in March, which would establish seven regional operators led by a single director in an effort to create cohesion between the regions across England.

“The creation of seven integrated regional teams with wider responsibilities and greater power offers significant opportunities,” said Hopson. “And hopefully there will be efficiencies and cost savings which could diverted into frontline care.”

Image credit: Dominic Lipinski, PA Wire

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