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


The Ian Renwick case, at best, reveals some seriously poor communication between NHS Improvement and the trusts it regulates.

It seems fanciful that one part of NHSI, charged with keeping track of enquiries, complaints and whistleblowing, wouldn’t talk to another part, which puts improvement directors into trusts.

NHSI claims it was unaware of the allegations.

This is flatly contradicted by emails from NHSI to the whistleblower.

They show the enquiries, complaints and whistleblowing part of NHSI did know of the allegations Mr Renwick faced.

But even if it hadn’t done, you would hope NHS IMAS (interim management and support), the part of NHSI which runs a pool of consultants who can become improvement directors, would have been aware of his dismissal.

It had been widely reported.

The reasons for his dismissal were a mystery for two years but you’d think IMAS or someone linked to it would have asked what they were before sending him into another senior role.

NHSI says everyone in this pool had to provide four references – but it turns out none of them were from the place he spent the last 12 years. Gateshead Foundation Trust confirmed they were never asked for a reference.

Even if NHSI/IMAS’ people team somehow missed the dismissal news (and were somehow not told by the whistleblowing department), did no one think the lack of reference from Gateshead was odd?

Did no one at Medway think it was odd?

Did Medway really think to themselves: “Our new improvement director was dismissed from his previous chief exec post, we have no idea why and don’t care to ask”?

Last year’s Kark Review of the Fit and Proper Person Test made recommendations, judgement of which by ministers is still pending.

It specified things like mandatory references (as well as a Health Directors’ Standards Council) but these measures might still have had no bearing on this case, because Mr Renwick was an interim, not a permanent director, and not on the board at Medway.

Can it really be acceptable that NHSI subjects the senior, influential interims who it places into trusts to less scrutiny than they must apply to permanent board employees?

Less unwelcome than before

“To establish [integrated care systems] now as formal statutory bodies would… necessitate a major change to the NHS’ existing organisational and accountability structure; would require a fundamental reassessment of the functions of CCGs, NHS trusts and foundation trusts, and their relationship with national oversight bodies; and would be an unwelcome disruption and distraction at this point.”

That was the finding of NHS England’s engagement with the sector and Commons health committee, completed just a year ago, on what legal changes were needed to help the NHS.

NHSE is expecting that the crucial legislative step, of drafting the actual bill, will take place in the next nine months. And Sir Simon Stevens has told HSJ it must give a “legal form” to ICSs. That’s not quite the same as a “formal statutory body” but it’s pretty close, and it seems likely the government would draft the legislation further towards such “disruption and distraction”.

Perhaps now, with a majority government, an NHSE regime reaching its twilight, and a pandemic having put everything in perspective, such a move has become less “unwelcome” - or if not, then inevitable.