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

HSJ research published today reveals what many in and around integrated care systems will have expected, and many of their prospective partners will have feared.

That is, the NHS bit of ICSs – the NHS integrated care board – has been set up first, with integrated care partnerships and “places” not yet having leadership or governance decided in many areas.

One question is whether this is simply a by-product of the legal mechanics (ICBs will be legal bodies which have to take on staff and obligations from clinical commissioning groups on 1 July), or if it betrays an inbuilt NHS obsession and bias from day one.

Another is whether it is really a problem. Many ICS leaders are keen to make them more than an NHS outpost, and people within and outside the NHS are watching keenly to see if “place” is made real.

But HSJ has argued against an obsession with ICS devolution and subsidiarity, saying instead that systems should be given space to deal with some early core asks emanating from the NHS – winter and cost savings, for example – before having to hand power to a complex cast of partnerships. 

We also establish a useful and important fact: there are 175 “places” in the English NHS. This appears to accord with the Nigel Edwards rule of restructure, that no number should be repeated.

Ministers vs money

Government ministers have increasingly opposed proposed pay deals for top NHS managers in recent years, but only managed to block four of them, figures show.

HSJ’s freedom of information request to the Department of Health and Social Care found 278 cases had been submitted by local organisations between 2019-20 and 2020-21.

Trusts are required to obtain ministerial approval if they wish to appoint a very senior manager on a salary that is at, or above, £150,000.

However, although ministers can formally reject these for NHS trusts, they are only allowed to “comment” on them when it pertains to foundation trusts or CCGs.

HSJ found that, across the three-year period, a total of 48 were “not supported” by ministers. This increased from 10 in 2019-20, to 18 the following year and then 20 the year after that.

When it came to formal rejections, three were blocked in 2020-21 before only one was in 2021-22.

This is a legacy of Jeremy Hunt, the former health and social care secretary, who introduced the measures in June 2015. It was first set at £142,500 before increasing to £150,000.

Managers in Partnership chief executive Jon Restell described it as a “pointless, delaying feature”.

Also on today

In our comment section, Naomi Chambers and colleagues discuss the activities that should feed into and come before acting on the Messenger report’s recommendation for a single set of unified core leadership and management standards for managers, and in The Ward Round, Annabelle Collins says the NHS is preparing for potential conflict over the Pay Review Body’s recommendations in July.