NHS England ‘hasn’t got long’ to develop ‘operating model’ for system working

Despite ICSs formally launching on 1 July, the chiefs said there was still no clarity about how the service would be supported and held to account as the Health and Care Act reforms are rolled out and the stuttering covid recovery continues.

However, the trust CEOs also praised NHSE chief executive Amanda Pritchard for her willingness to tackle the service’s problems together with local leaders.

The CEOs were speaking at a roundtable to mark the publication of HSJ’s annual ranking of the NHS’s “top 50 trust chief executives”.

NHSE has been working on a new operating model since last year. It has confirmed it plans to keep its seven separate regional teams, and has recently indicated national programmes will be curbed as part of reductions to central staffing. 

Caroline Clarke, the chief executive of north London’s Royal Free group of trusts, said: “What’s unclear to me is, what the operating model is for [the] whole NHS? What is NHSE going to do… what’s expected of the regions and the ICSs… is the performance management line [for providers] going to go all the way through the ICS?”

Ms Clarke said she recognised “some kind of regional infrastructure” was needed and that the existing set-up made sense in widely recognised areas such as London and other “urban” conurbations. But she added: “Are [regions] just going to be aggregating features of the NHS, or are they actually going to have a kind of intent to them?”

Ms Clarke said she was “hung up” on getting an effective operating model because, without it, there was an increased chance NHSE staff would “get in the way and stop us making decisions”.

Frimley Health Foundation Trust chief executive Neil Dardis said parts of the system were struggling to “understand their purpose.” He thought both NHSE’s national team and local providers were “really clear” on their purpose, but there was a “sticky middle” consisting of regions and ICSs that were not.

“I think we may have been caught in this trap between kind of local determination and permissiveness versus real clarity of purpose,” he concluded.

Royal Berkshire FT chief executive Steve McManus also picked up on the “permissiveness” of the reforms and how they could “bake in” regional variation. He said NHSE’s national and regional teams needed a clear operating model which would address the issue of “how do we have consistency of performance, quality and access around the country”.

Birmingham Women’s and Children’s FT chief executive Sarah-Jane Marsh admitted she did not “understand” how NHSE proposed to manage the service.

Ms Marsh, who also chairs NHSE’s Maternity Transformation and the Children and Young People Transformation programmes, said the lack of clarity around the service’s new operating model in part stemmed from NHSE’s own internal problems.

“I’m not sure that there’s enough focus on actually running NHS England as an organisation of a significant number of people,” she said.

Gloucestershire Health and Care FT chief executive Paul Roberts told HSJ: “We’re in a very complex transition at the moment… [and] NHSE is going through a very big reorganisation itself. There are lots of moving parts, and the complexity of that challenge for Amanda and her team is huge. She hasn’t got long to sort it, actually, because we need that [the operating model] to be clearer.”

Northamptonshire Healthcare FT and Leicestershire Partnership Trust chief executive Angela Hillery said: “We haven’t got the clarity about who plays what roles, and that is confusing.”

She added the NHS could not “ignore” the “complexity” of new reforms or “assume” they would be managed “through an ICS”, and said NHSE needed to “spend more time thinking about how they consider complexity and how you then… construct the supporting architecture”.

Beccy Fenton, partner and UK head of health & human services at KPMG – which sponsored the Top 50 – said the trust chief executives she spoke to said there was a “complete lack of clarity around the operating structure from top to frontline that needed sorting out”.

She continued: “Who is responsible for what, and how is that going to work to deliver a different agenda? And the agenda is different now, it is [improving] population health.”