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The merger of the NHS’ central emergency and elective intensive support teams presents threats, opportunities and an interesting steer on national bosses’ plans for integrating the wider improvement agenda, argues James Illman.

Nearly every executive at a struggling trust will tell you they could do with less visits from the NHS’ plethora of central improvement teams.

This is not to put down the work of the individual improvement teams. Many have delivered demonstrable improvements and will continue to do so. But there is a sense too many cooks have been spoiling the improvement broth for some time.

There’s the emergency care intensive support team; the elective care intensive support team; the numerous Getting It Right First Time and RightCare teams; or maybe NHS emergency care tsar Pauline Philip just dropping by to give one of her famous pep talks.

Those in the improvement teams are cognisant of this. They say it’s hard to get buy-in from busy trust chiefs when they’re competing with a small slice of capacity with so many other improvement programmes.

They also point out that the dynamic has changed over the last few years from a system in which they were invited in by trusts to one where they are sent in, which has sometimes created an unconstructively awkward starting point.

Well, this could be about to change, albeit slowly, and out of grim circumstances which has seen the NHS lose well-regarded staff and significant capacity.

The emergency and elective support teams are being merged as part of efforts to cut 20 per cent off NHS England and Improvement’s running costs.

Like the other cuts programme ongoing across NHSE/I, the process of bringing together the intensive support teams has been painful. Loyal and long-serving staff are being made redundant or pushed out of roles, while a climate of uncertainty pervades.

But senior figures from within the improvement teams and other NHS watchers have suggested this could be the beginning of a much wider integration of central improvement teams. And this, in the longer term, could have profound positives, even if the capacity being stripped out is a significant concern.

The new “Intensive support (urgent and emergency care)” team is being headed up by Stephen Duncan, who was appointed over the summer having previously been the deputy of the ECIST team.

The former well-regarded head of the emergency team, Russell Emeny, left the NHS over the summer. His elective counterpart Nigel Coomber, also well respected, has also left the central team to take up a role with the East of England regional team.

ECIST had initially managed to reduce its costs by the 20 per cent target by cutting its panel of clinical associates. The move was predicated on efforts to not make permanent staff redundant, HSJ understands.

The panel of around 20 clinical leaders, who could be called upon ad hoc, carried out varied roles, doing anything from a day-a-year to a day-a-week.

They were widely viewed as one of the most valued aspects of the ECIST offer – and should they be permanently jettisoned, this would represent a significant blow and a major handicap going forward.

There was consensus among several senior figures contacted by HSJ that the clinical associates played an integral part in securing the clinical buy-in integral for any change programme.

HSJ was, however, told the matter had been recognised by senior figures within the NHSE/I improvement directorate, led by Hugh McCaughey. There had been assurances the clinical associates panel would be reintroduced, two sources told HSJ.

But no budget has been allocated for them yet, and until it is, nothing can be viewed as guaranteed.

Sources have also raised concerns about what it means for the elective side and that, despite the NHS’ mounting waiting list, electives will play second fiddle under a set-up which will be far more focused on the emergency work.

But elective waiting list expert and HSJ contributor Rob Findlay of Gooroo disagreed and said the changes could ultimately help deliver a more “holistic approach”.

He said: “It has always struck me as an anomaly that elective and emergency care are dealt with fairly separately from pretty much the top to the bottom of the system, until they do battle on the wards.

“Both elective and emergency admissions are competing for the same bed capacity. The merging of the elective and emergency intensive support teams presents a real opportunity to take a far more holistic approach which could ultimately be more helpful for flow throughout the hospital and the wider system.”

There is no doubt that losing capacity from the improvement teams – many of which were incredibly lean already – will be tough. Persuading people to join these teams is also not an easy gig.

But a rethink around the collaboration between the various improvement teams has long been needed, and the current circumstances provide the catalyst, even if there is nothing to celebrate about the cuts required to the central teams.