The must-read stories and debate in health policy and leadership.

Pressing pause

Unions will be celebrating after NHS Improvement ordered a temporary stop to the creation of wholly owned subsidiary companies and any changes to existing companies.

As revealed by HSJ in July, NHSI are planning to consult on a new regulatory approach to trusts wanting to establish or change wholly owned subsidiary companies – and Wednesday’s announcement confirmed the consultation would start next month.

This year several trusts have attempted to set up subsidiaries, but subsequently abandoned the plans or had them rejected by the regulator.

Strikes are organised at two trusts by unions concerned that such companies will create a two tier workforce.


Back in the spring, it only took one look at the proposals to substantially integrate, but not actually merge, NHS England and Improvement to see they were going to be very difficult to make workable.

So it has proved, with one of the first hurdles - selecting the top tier of directors - not jumped, nearly six months after the first early details of the structure were published.

In May, NHS England and Improvement said they hoped to minimise “uncertainty for colleagues” and “the risk to the system of a lack of continuity” by getting things sorted as quickly as possible, including resolving the top tier “by September”. Job ads have only just gone out for most of the top tier roles, and some are still awaited.

Meanwhile gossip rumbles on, with one question being whether any credible chief executives would be willing to take on a regional director role (with the enviable opportunity to report to the separate chief executives of both organisations). Another is which of the current postholders will be slotted into new jobs rather than move on.

Babylon calling

Babylon Healthcare has spent much of this year attempting to expand its relationship with the NHS, with mixed success.

In response to Freedom of Information Act requests from HSJ, 17 clinical commissioning groups disclosed contact with the company, which provides GP video consultations and other digital products.

Much of the correspondence related to Babylon’s NHS GP partnership, GP at hand, including plans to expand into Leeds and Southampton.

A few included some back and forth over difficulties in finding space for new clinics, or convincing neighbouring commissioners to pay for GP at hand referrals.

Others related to the NHS 111 online product the company developed with the NHS in London. 

Most of the discussions have not, thus far, resulted in expansion of the company’s NHS footprint.

Babylon says commissioners have known about plans to expand GP at hand for at least nine months and have failed to make provisions for this.