Ed Smith review: Recommendations in full

Recommendations to be implemented in full

1) National strategies for both improvement and leadership development will be created for the health and care system to support the delivery of the Five Year Forward View.

2) Every NHS organisation should develop strategies setting out their approach to improvement and leadership development, which are aligned to the national strategies.

3) The new arrangements for improvement and leadership development should be governed collectively by two national governing boards, comprising senior representatives from the six national organisations, and the Department of Health.

4) Reporting arrangements for intensive support teams and the core NHS Interim Management and Support teams should continue while consideration is given as to where these functions are most appropriately hosted in future to support delivery of the national strategy for improvement.

5) Standard operating models should be developed which set out how the different parts of system should be aligned and work to support delivery of service improvement, service transformation and service intervention activities.

10) NHS England should host a small team to provide thought leadership and support for the specific programmes focused on the delivery of the forward view.

11) Clinical senates, strategic clinical networks and academic health science networks should continue but with clarified roles, closer collaboration and more alignment.

• Clinical senates’ role should be: providing evidence based clinical advice to commissioners and providers on major service changes.
• Strategic clinical networks should be renamed “clinical networks”. Their role should be: connecting commissioners, providers, professionals and patients and the public across a pathway of care to share best practice and innovation, measure and benchmark quality and outcomes; and drive improvement.
• The fifteen academic health science networks should continue, though they should not be discouraged from merging. Their role should be: supporting the NHS and contributing to economic growth by enabling and catalysing change through collaboration; and the spread of innovation and best practice.
• AHSNs and clinical networks should be streamlined and their business plans aligned, so that they operate as a single support entity for local systems.

14) The NHS Leadership Academy should be accountable to the new national governing board (see recommendation three, above).

Recommendations to be partially implemented

6) NHS Improving Quality will cease to operate as a national organisation and resources will be redeployed – however its resources will be deployed across the system at a national level, but not locally.

9) Responsibility for commissioning programmes to build improvement capability across the system will move to NHS Improvement, rather than to NHS Leadership Academy as originally proposed.

12) The relationship between NHS Leadership Academy and Health Education England to be strengthened – as announced by the government this month, the academy will become part of HEE.

13) Redefining the NHS Leadership Academy to focus on evidence based leadership, talent management, systems leadership, leadership development – responsibility for talent management will go to NHS Improvement.

Recommendations for future discussion

8) A one stop shop should be created to provide central resource to support national and local improvement – NHS England leading this, working with NHS Improvement.

15) Alternative financing and business models for NHS Leadership Academy to be considered – including direct funding by local organisations.

16) Change of name for NHS Leadership Academy -– HEE to review this.

Recommendations not to be implemented

7) AHSNs will not lead the coordination of local improvement activity as the Smith review recommends. However, they will continue to play an increasingly important role in improvement along with clinical networks and clinical senates.