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

One of the reasons combining NHS England and Improvement has been resisted for a few years now is the long and drawn-out distraction from the day job, with damage to morale and miserable agonising over job losses and people’s future.

Probably less of a consideration – though a cost nonetheless – is that of the redundancies, including the high-value senior ones.

Yet NHSE and I and ministers last year decided they would bite the bullet; adopting plans for an ever closer union, accepting they needed to share a single finance director. Then, early this year, it was decided they also needed to share a top-dog chief executive (and even a single comms director) – culminating in the pushing out of Ian Dalton and Matthew Swindells.

This week, the impact across the organisation is there for all to see, with a staff consultation on the biggest phase, affecting the large majority of the organisation and putting more than 900 people at risk of redundancy, launched on Tuesday. Some have noted the unfortunate timing, shortly after NHSI’s accounts, which reported the substantial redundancy payouts to some of the senior victims of the restructure at NHSI last financial year.

For others, the sheer scale and complexity of the changes have hit home, with 20-odd annexes to the consultation documents listing seemingly endless posts which are in and out of the new structure, which many will struggle to get their heads around. The organisations together employ some 7,000 people.

A number of people have commented on particular teams – local/regional operational and direct commissioning teams, for example – seeing headcount reductions well above the 15 per cent headline reduction figure; and indeed NHSE/I say they are directing resource for “reinvestment in new roles required to deliver the new organisation operating model”. These are thought in particular to include the new focus on workforce/human resources; although the overall shifts between functions and regions remain unclear.

Some HSJ readers commenting have reported poor handling, citing an awkward applause after deathly silence as NHSE chief Simon Stevens announced the changes, and problems with presentation and explaining. Senior leaders have long reported the shadow cast by the uncertainty created, which has been going on for substantially more than a year now, and drags on towards the end of 2019. The judgement is how far these issues are attributable to huge complexity and other inevitabilities, versus poor handling, as some readers report.

Dudley’s road ahead

When Dudley Group Foundation Trust published a much-anticipated independent report into whistleblowers’ allegations of bullying and harassment within its leadership, some would have thought the issue put to bed.

The report, carried out by law firm Capsticks and released in May, did not substantiate the concerns raised last year by 42 anonymous consultants about a culture of “systemic bullying” from some of the trust’s executive team. 

However, according to doctor’s union the Hospital Consultants Specialist Association, the concerns are very much alive among a significant number of consultants. The union told HSJ it has been contacted by “dozens” of consultants who say the concerns have not been addressed and believe the independent report was a “whitewash”.

This has prompted the union to call on the health and social care secretary to intervene.

Some consultants, who contacted HSJ through the trust’s press office, have offered support for their executive team and say they do not share the concerns the HSCA outlined.

However, even if the concerns raised by the HCSA represent just a select few, Dudley Group seems to have some way to go before its cultural issues are ironed out.