by Jennifer Berger 7th March, 2019
5 min read

Reorganisation of the NHS – 10 things we have learnt

To celebrate it 70th Birthday the NHS has been partaking in two of its favourite activities – reorganising and developing long term plans. Since the inception of the Health and Care Act in 2012, the NHS has slowly but surely been moving away from the commissioner/provider split set out in the Act as NHS leaders shifted policy toward a health and care system centred around population based integrated services. Here are 10 pieces of news we have learnt about the latest reorganisation.

  1. A merger in everything but name – As of April 2019, two major NHS arms’ length bodies. NHS England (NHSE – oversees commissioning) and NHS Improvement (NHSI – oversees provider quality) will aligned under one management team, with Simon Stevens, current CEO of NHSE leading both organisations with the help of a new Chief Operating Officer. Due to the restrictions of the 2012 Act, the organisations will, for now, retain separate boards and chairs. The alignment will also lead to the creation of seven regional integrated teams in England and an NHS Assembly which intends to bring together health and care stakeholders to develop the NHS Long Term Plan.


  1. Old and New faces – When NHSE and NHSI announced most of its top teams in December 2018, many of the roles were filled by people already working in one organisation. There have since been some notable non-NHS establishment hires with new NHS Chief Financial Officer, Julian Kelly, former lead of the Defence Nuclear Organisation at the Ministry of Defence and Prerana Issar a former United Nations Food Programme and Unilever HR officer taking in the newly created Chief People Officer role. All eyes will now be on the appointment of the new Chief Operating Officer, an ambiguous role at this stage as the person would in principle be head of NHSI, but still report into Simon Stevens.


  1. Workforce is an emerging priority – The Long Term Plan workstream which has picked up the most pace is workforce, with a workforce implementation plan set to be published in March.


  1. System integration is here to stay: – Central to the Long Term Plan is the ambition to see become Integrated Care Systems (ICS) rolled out across the whole of England by 2021. This is a significant ask considering that many localities are struggling to make their Sustainability and Transformation Plans off the ground, let alone turn them into fully functioning population health based local systems.


  1. Changes are needed to primary legislation – Another hurdle to both the merger of NHSE and NHSI and health systems is the need for primary legislation to amend the 2012 Health and Care Act. In a time of Brexit, with bills thin on the ground, this will be a tall order, however there is hope that cross-party agreements on changes could be reached through the involvement of the Health and Social Care Committee, which will be scrutinising the NHS’s legislative proposals before they make their way to the House of Commons chamber,


  1. The CQC will continue to inspect systems. In February, the Care Quality Commission wrote to the Health Select Committee to report its concern that the Department of Health and Social Care had not renewed its remit and funding to continue the Whole System Inspection programme, however Matt Hancock has since confirmed the CQC has been given the green light to continue inspecting systems, although the level of funding and number of systems to be carried out are still to be determined.


  1. What about non-NHS stakeholders? Integrated Care Systems can only work if all stakeholders involved in supporting local population are active partners. However, these is a developing sense that ICSs are being driven mainly by the NHS, with stories of local authorities pulling out of ICSs. This should be a major concern as local authority provide and commission many of the preventative services (social care, social services) which relieve pressure on the NHS. Without them it is difficult to see how ICSs will be able to address the needs of the population.


  1. Digital is being integrated as well: Technology has always been Secretary of State Matt Hanock’s main interest and it seems he quickly lost patience with the disparate way the digital agenda was being managed between NHS arms’ length bodies. In February, Hancock announced, the creation of NHSX, a ‘new joint organisation for digital, data and technology’ to ensure patients get the most out of technological advance, while positioning the UK as a leader in medical research.


  1. All eyes on the Chancellor: Both the NHS and the DHSC have grand ambitions for the direction of the health services and the £20bn it received for its 70th Birthday will go someway to meet these ambitions. However, there are still crucial aspects of healthcare, such as workforce, capital and social care which did not receive extra funds. The assumption is that these will be addressed in this year’s Comprehensive Spending Review, however the uncertainty of Brexit coupled with other Departments putting forward their funding demands, means that there will still be an upwards battle to prove to the Treasury why health and care should once more be a funding winner.


  1. Social care is still the elephant in the room: It is a truth universally acknowledged that without community care people will come to hospitals. And yet there is still no sign of the Social Care Green Paper which is supposed to help secure the future funding and sustainability of the sector. Health leaders are busy building a house of cards to helps keep the NHS a world leader in health and innovations, all the while stubbornly ignoring that the foundations have seen much better days.
See more articles by Jennifer Berger