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Commissioning board and Trust Development Authority directors handed responsibility for 2012-13 delivery

Senior leaders appointed to the NHS Commissioning Board and NHS Trust Development Authority are to take on ‘management responsibility’ for the delivery of NHS performance in 2012/13 from 1 October, six months before the abolition of PCTs and SHAs. This is in addition to existing respective responsibility for commissioning development and the foundation trust pipeline.

However, PCTs and SHAs will remain the legal accountable organisations for delivery until their abolition. Reporting lines are likely to differ across the country depending on local arrangements. In some case the relevant commissioning board and NHS TDA leaders are likely to report through PCT and SHA management structure on matters of 2012-13 performance, elsewhere they will report  through the new organisations.

NHS chief executive Sir David Nicholson announced the changes in two letters to the service today. He said the arrangements would be discussed with leaders in each locality and put in place “from 1 October”.

He said the DH had decided to take the step to “ensure stability and resilience”. It follows high level concerns about responsibility remaining with those senior leaders in the current system who do not have a job in the new system from April next year, or who may be moving to significantly different roles.

The change will mean that - although SHAs and PCTs will retain their statutory accountability - their leaders are stripped of management control.

HSJ understands those who have proposed the early move include some of the outgoing leaders, and in particular it has been welcomed by the current SHA cluster chief executives.

A letter to all NHS system leaders, including clinical commissioning group chairs, says: “To ensure stability and resilience for the current system through transition, the NHS Transition Executive Forum [a DH committee] has agreed that NHS CB and NHS TDA regional directors should take on management responsibility for the teams managing both 2012-13 operational delivery and planning for 2013-14.

“For the NHS CB, people appointed to future regional and local leadership roles in the NHS CB should take on management responsibility for the teams managing both 2012-13 operational delivery and planning for 2013-14. For the NHS TDA, people appointed to future delivery and development director roles in the NHS TDA should take on management responsibility for both 2012-13 operational delivery and planning for 2013-14, in respect to the [foundation trust] pipeline and provision system.

“NHS CB and NHS TDA leaders working in this way will be accountable to their new organisations for future planning and development and be accountable to PCTs/SHAs for relevant delivery and performance in the current system for 2012-13. These arrangements will embed new system leaders in the current system, providing continuous leadership and minimising complexity for staff carrying out roles relating to the current and new system.

“[Health Education England] and shadow [local education and training boards] will take on delegated authority for 2013-14 planning functions for workforce planning, education and training from 31 October 2012. [Public Health England] will prepare to take on its functions from January 2013. The arrangements I have outlined above will not impact on clinical commissioning groups or local authorities as they prepare for their key roles in the new health and care system.”

The letter acknowledges that: “There will be no formal transfer of statutory functions, accountability,and PCTs retain their statutory functions and governance arrangements. New bodies will only be accountable for responsibilities consistent with their preparatory powers and planning for 2013-14.”

In another letter, to SHA and PCT chairs, Sir David says: “As we are entering the final phase of transition to the new health and care system, I want to take this opportunity to thank you personally for the professional commitment you have brought to your specific roles and to the wider NHS.

“To say that this process has been challenging at times is, of course, a huge under-statement. Although we have all been responsible for complex change projects in the past, none of us have dealt with anything on this scale before.

“We have reached a crucial stage in the process and the new system must now gear up for the challenges it faces. To succeed it will continue to need your support more than ever and I am very grateful for that which has been given so willingly…

“This should be the last significant organisational change prior to April 2013. It will have considerable impact on PCT chief executives and boards and will present a huge leadership challenge.”

A DH spokeswoman said that it will be decided for each area separately, in discussion with its leaders, who will be the accountable officer for each organisation. Currently SHA and PCT cluster chief executives are the accountable officer for all of their patch. In some areas this responsibility may pass to the relevant director in the NHSCB or NHSTDA, the DH spokeswoman confirmed.

Readers' comments (18)

  • On your marks, get set, first one for gold (redundancy) - who said the Olympics was over

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  • So, in effect they are making PCT CEs redundant from 1/10. One assumes if they do not wish to take up any of the offered 'secondments' payment in lieu of notice will be their legal entitlement?! All part of a well managed and thought through process?

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  • Could it be that the new 'brooms' are not sweeping hard enough.
    Prehaps it needs STOMP to be engaged after their closing gig last night.


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  • Thank-you and cerchink..... another jackpot redundancy hits the CCG's where it hurts ... who would work for the NHS when you can set up your own company and still have the golden goose...?

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  • Richard Russell

    First reading of the article seems to make a lot of sense. If we had a 1/4/13 switch off/on date then we would lose all of the context/history/relationships residing with the staff being made redundant.

    This way the staff taking up the new posts will still have access to all this knowledge and expertise as they develop into their roles.

    Also I am sure that there will be gaps in how the new organisations have been set up to run, at least operationally. This gives time to identify those gaps and sort them before it becomes a critical part of the process.

    I sometimes think there isn't enough dual running during a period of big change and for one I welcome this approach.

    Cannot make it easy for the people who do not have a role post 1/4/13 to stay engaged but I think that has been true for a lot of people throughout the uncertainty.

    On a slightly tongue in cheek note - for those staff not in post after 1/4/13 who are now accountable but not responsible - does it mean that they now cannot fail (as not accountable) or cannot succeed (as not responsible) or both...

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  • Good point about the PILON. Anyone know whether it's legally compulsory to accept a secondment, or can you just take the money and go?

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  • Accountable but no managerial control !
    Can these be separated

    Confused.com

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  • Ref 3.10 and PILON. I understand that you cannot be forced to take a secondment. If they take your substantive role away from you on 1/10 then they are making you redundent, with all that that entitles.
    They are relying on goodwill to make people willing to work their notice period. Perhaps DN needs to recognise this in writing instead of a bland email to allChief a executives in the NHS?!
    I am sure John Restell from MIP will be writing to each of his members accordingly, maybe he could tweet the link to MIPs legal opinion?

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  • Those Doctors with Clinical accountability should be mindful of risk of referral to GMC for management responsibility role in the event of complaints.

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  • Thought this was the idea! A big plea as you are dealing with skilled people, so lets have proper support for them please!

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  • Can you hear that gurgling sound?
    That's my goodwill going down the drain.
    MIP will be busy tomorrow.

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  • This will be the organisations that are not yet authorised or have statutory powers that will be responsible, but not accountable? In the week following Winterbourne View SCR - we separate accountability and responsibility in the system? You people are MAD! NO management responsibility but all the accountability? I can't wait to get that directive!Or to reply to it!

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  • The sad thing is that the initial decision towards the brave new world was made on a wish and a prayer - now we feel some relief that the current induced meltdown may come to an end, even if the new way is not better (jury's out)

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  • It's not just PILON!

    Surely this creates a case for every PCT executive to go for constructive dismissal...

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  • I thought about the constructive dismissal issue but don't execs have a 6 month notice period? Which is how long there is between this starting and the new system.

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  • Constructive dismissal is a form of dismissal. If you resign from your job because of your employer’s behaviour, it may be considered to be constructive dismissal. You would need to show that:
    Your employer has committed a serious breach of contract
    You felt forced to leave because of that breach
    You have not done anything to suggest that you have accepted their breach or a change in employment conditions

    This is the definition from Direct Gov.

    Where is MIP in all of this?

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  • Surely the PCT/SHA relationship has always been one of accountability without management responsibility....? So they go out as they came in.

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  • Good to see an acknowledgement that SHAs and PCTs have an accountability relationship. The 'soft touch' has been so soft in many cases it has become invisible.

    Does this tell us anything about what the NCB knows about Francis that we don't?

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