Daily Insight: New narrative needed

Given the headlines around elective recovery, emergency care crises and new health ministers, it’s easy to forget there is a complex merger happening at national level.

For anyone who needs reminding, NHS England is swallowing NHS Digital and Health Education England in a process which is due to be completed in April 2023.

Merging organisations with thousands of staff is a tricky business, and interim NHSD chief executive Simon Bolton this week warned that the bodies had “lost the narrative” of the merger, partly due to a “fixation” with headcount reduction.

NHSE has previously set out plans to reduce staff numbers by as much as a third, so it is little wonder the “narrative” was fragile.

Mr Bolton expressed a wish that the process should be driven by the aspiration to deliver “much better value for patients and clinicians”, and he suggested this would lead to reduced staff numbers anyway.

“The prize is delivering better value quickly rather than focusing on headcount reduction”, he told delegates of the HETT 2022 conference.

If the merger is to deliver such benefits, then the importance of regaining control of the “narrative” around this project cannot be under-estimated.

Power shortage

Sheffield Teaching Hospitals has had a rough few years, weathering a brace of critical Care Quality Commission reports. Following the first downgrade and damning criticism of maternity, the trust commissioned external experts to take a fresh look at the trust’s governance.

The timing was fortuitous, with the external review landing earlier this year shortly after the care watchdog moved the entire trust down from “good” to “requires improvement”. Some of the critiques in the review – which was provided to HSJ following a freedom of information request – echo those made by CQC inspectors.

Sheffield operates a devolved leadership structure of 11 clinical care groups overseen by a central team. However, this was described as “relatively small” for such a large organisation and resourcing of healthcare governance in directorates was said to be “surprisingly variable”.

Other issues included “potentially considerable” under-reporting of freedom to speak up concerns, which has prompted the trust to investigate further.

The review’s main criticism – and the document does highlight positives across the organisation – was a sense of “disempowerment” among directorate leadership teams. This was partly attributed to a “risk-averse culture” where decision making was not devolved but punted up to an “overly bureaucratic approval process” at trust leadership level.