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Analysis: Nicholson triggers shift in control to new system leaders

Sir David Nicholson has announced a major shift in power to the new NHS, which will see control pass from many primary care trusts to leaders in the NHS Commissioning Board and NHS Trust Development Authority.

The NHS chief executive wrote to senior staff last week ordering the change, which will take effect from October and he said would “ensure stability and resilience for the current system through transition”.

Sir David said commissioning board and development authority regional and local directors should “take on management responsibility for the teams managing both 2012-13 operational delivery and planning for 2013-14”.

Several senior commissioners told HSJ it meant in their area local area team directors would take over control from PCT cluster chief executives. In some areas it is expected the area director will take over as statutory accountable officer.

However, the letter also said: “NHS CB and NHS TDA leaders working in this [the new] way will be… accountable to PCTs/[strategic health authorities] for relevant delivery and performance in the current system for 2012-13.”

And HSJ understands some SHA cluster chiefs will keep performance responsibility until the organisations are abolished. Arrangements will be allowed to vary between areas, decided by discussions at SHA cluster level.

Where there is a shift in control, it means PCT and SHA leaders are having their “management responsibility” removed, six months ahead of their abolition.

The Department of Health has stressed the announcement is not related to current chiefs’ ability to deliver, and HSJ understands the announcement had been previously agreed and welcomed by SHA cluster chiefs.

In one of two letters to NHS leaders Sir David said the change “does not mean [SHA and PCT leaders] have no further role to play”. He explained: “On the contrary, their skills, experience and dedication to the staff they lead will be even more important as they support new system leaders in managing a smooth transition.”

However, many PCT cluster chiefs were not expecting the announcement, and some were angered by it.

One told HSJ: “Some people have taken a view that it is their job to oversee PCTs’ final months of existence, and have turned down other job offers to make sure that happens [in a successful way]. They may now be reviewing the appropriateness of that loyalty.”

And Wiltshire and Bath PCT cluster chief executive Ed Macalister-Smith, who plans to retire from the NHS next year, said: “Our board had discussed the need to accelerate the handover and model new ways of working a number of months earlier and we are implementing that.

“However the tone of this letter is not particularly helpful for people who are working their socks off in difficult circumstances, trying to make this transition work.”

Several cluster chiefs and commissioning board local directors said ordering an early handover of responsibility for delivery was sensible. They said it would reduce risk as increasing numbers of SHA and PCT staff left, were given jobs in the new system, and as their employers’ abolition approached.

Some said it would reduce the otherwise huge risk of the new system taking on responsibility immediately on 1 April, directly after SHAs and PCTs were abolished at the end of March.

However some raised concern that many senior posts in new organisations will not be filled by October, meaning a later transition may be better. Commissioning board and NHS commissioning support units appointments are both behind schedule. One PCT cluster chief said: “1 October may be a bit optimistic. A bit of flexibility locally may be required, but with an absolute deadline of 1 December.”

North East Essex CCG chief executive and GP Shane Gordon, a member of the NHS Clinical Commissioners leadership group, said the move would shift responsibility and staff to the new system. He said: “Unless people feel the platform is burning under them they are not going to get a wriggle on and do it [change].”

Readers' comments (6)

  • This move is a good feature of the transition and seems entirely sensible. System leaders who have turned down good job opportunities to see the existing system through to 1 April 2013 are noble but perhaps naive.

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  • There is a danger that the accountability and governance arrangements for this have not been thought through. It would be worth clusters getting legal advice to help ensure that eyes are not taken off balls and that they don't risk another Mid Staffs handover failure - or JR if they are handling contentious issues like service reconfiguration.

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  • NHS = Nicholson Health Service®

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  • Oh David, you're so masterfull....

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  • This can only be welcomed from a ccg perspective. It will be good to feel we are moving forward and onwards to the new world rather than stuck in the PCT world.

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  • Stuck in the PCT world? You'll have none of the power or control of PCTs, but all the hassle and headaches. Good luck. You'll need it. Roll on the next restructure!

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