NHS England and NHS Improvement have appointed two joint regional directors, in order to “test a more integrated approach” between the two organisations.

There will be a joint director for the South East, Anne Eden, currently NHSI’s regional managing director for the South; and a joint director for the South West, Jennifer Howells, who is currently NHS England’s regional director for the South West and its interim for the South East.

Matthew Swindells

Matthew Swindells

Matthew Swindells: ‘NHS England and NHS Improvement have rightly been under pressure to integrate our working’

With the previous “South” region split in two, there are now shared regional directors for two out of five NHS regions. There are still separate roles in London; the North; and Midlands and East.

Sharing regional directors across NHS England and NHSI has been under consideration for at least a year, but was previously set aside because of a desire to avoid the disruption and complexity involved.

Among the challenges is the fact that NHS England and NHSI, which is legally constituted of Monitor and the NHS Trust Development Authority, have different and potentially conflicting responsibilities.

A note to staff today from Matthew Swindells, NHS England director of operations and information, said the change is “not a formal legal or employment change”. Details of the new approach will be decided between now and autumn when it will come into effect.

Mr Swindells said: “From autumn onwards, we will continuously evaluate the changes to tweak and improve the operating model before deciding whether any changes should become permanent, at which point they will become subject to consultation.”

There are several shared directors across NHS England and NHSI already, but not in the senior operational role of regional director.

Mr Swindells’ message said: “Since the launch of STPs in early 2016, NHS England and NHS Improvement have been urging local health systems to put on one side their organisational interests and to focus on joint working to improve the service we provide to the public and reduce costs.

“Increasingly, across the country, we are seeing primary, community, acute service and CCGs break out of the constraints created by the ‘payment by results’ payment system and find solutions that are the best possible for their patients, even if the costs and benefits are not evenly distributed between the NHS organisations…

“NHS England and NHS Improvement have rightly been under pressure to integrate our working in a similar way and eliminate divisions arising from our separate organisations within health systems that are trying to work together. Together we have tried to respond to this…

“However, as the NHS continues to work more closely together at the front line, it behoves the national bodies to constantly challenge ourselves to be more joined up. We have therefore decided that the context and time is right to test a more integrated approach between NHSE/I.”

In an email to NHSI staff Jim Mackey said: “This approach will help us to get the very best out of two highly talented teams. There are lots of things we will need to work through together from now until the autumn to inform how this will work, such as on accountability and objectives, and we’ll learn from the shared roles we already have in place.”

A note to other organisations from Ms Howells and Ms Eden said: “In line with the collaboration that we expect from the entire NHS, we have agreed that we will test a more joined up model of working. This will help us to work better together to deliver the priorities set out in the NHS Five Year Forward View for the benefit of our patients and communities.”

At NHS Improvement, both chair and chief executive posts need to be filled in the next few months. A chair appointment is expected in the near future and HSJ revealed that former TalkTalk chief executive Baroness Dido Harding is a leading candidate. Current chief executive Jim Mackey is due to leave in the autumn.


NHS England has also in recent months made changes to its directors of commissioning operations’ patches in the South, which are now in line with its sustainability and transformation partnerships.

Under the South West region:

  • Rachel Pearce now covers: Bristol, North Somerset and South Gloucestershire; Gloucestershire; and Bath, Swindon and Wiltshire.
  • Mark Cooke covers: Devon; Cornwall; Somerset; and Dorset.

Under the South East region:

  • Felicity Cox: Surrey Heartlands; Sussex and East Surrey; Kent and Medway.
  • Dominic Hardy: Bucks, Oxfordshire and Berkshire; Frimley Health; Hampshire and Isle of Wight.

Updated at 1.20pm on 7 July to include Jim Mackey’s comment