North by North West: Exploring the exodus of NHSE directors

There’s been an exodus of senior directors from NHS England’s North West team in recent months, with regional director Amanda Doyle now heading for the exit after less than a year in the role.

Dr Doyle has been appointed to a national position heading up primary care, a role which on the face of it is much more in line with her experience and enthusiasm.

The four other recent departures were medical director David Levy, who is now chief medical officer for Lancashire and South Cumbria integrated care system; finance director Jonathan Stephens, now retired; performance director Graham Urwin, now CEO of Cheshire and Mersey ICS; and workforce director Anthony Hassall, now CEO of Pennine Care Foundation Trust.

The departures come as integrated care boards are about to be enshrined in law, and in a region like the North West, where there are three large ICBs, the regional directorate could quickly start to feel like an unnecessary layer of management.

Some trust leaders already think this is the case, saying the region has simply felt like a messenger service between them and NHS England’s national team during the pandemic, with local issues being managed by provider collaboratives.

Richard Barker, the regional director for the North East and Yorkshire, will now jointly oversee the North West as well, and NHSE would not be drawn on whether a dedicated replacement for Dr Doyle would be sought.

While there are no immediate plans to move to a single NHSE team for the North (as per pre-2018), this will surely be considered if the region’s ICBs get up and are running successfully.

Off pace on place

With only a month to go until ICBs become legal entities, Greater Manchester still seems to be struggling to confirm the “place leads” for all its 10 boroughs (in contrast with the traditional laggards in Cheshire and Mersey).

NxNW understands the majority will be led by the local authority chief executive, which is the model preferred by ICB chair Sir Richard Leese (a long-time leader of Manchester City Council), but there are a few boroughs where the arrangements have still to be approved.

Earlier this year, an internal paper outlined an alternative model where an NHS trust executive could hold the role, but said this would only be considered where there is “a clear rationale”.

It didn’t say what would happen if there was disagreement over whether that case had been made, however.

Reconfiguring Liverpool

The configuration of hospital services in Liverpool is possibly more complex and confused than that of any other city.

There are six providers, masses of service duplication, a big financial deficit, some serious quality concerns and a long-standing failure to attract the levels of research funding it should do.

And despite the efforts of local commissioners since at least 2014, there’s no clear agreement over what the future configuration should look like.

Although tentative talks around the concept of a “United Hospitals of Liverpool” began recently, these are so far only focused on one or two specialties.

NHS England now seems to have realised some external pressure is needed to push things along - and has told the Cheshire and Mersey ICS to commission an independent review.

The review will “go further” than current transformation programmes, the ICS says, by recommending “a long-term optimum care model” for all acute and tertiary services in the city.

This sounds like it will set out how many providers there should ultimately be and suggest ways to accelerate the integration of clinical services between them.

It should also determine what to do about Liverpool Women’s Hospital, for which there’s a lack of consensus around its relocation plans, and look at what the city needs to do to boost its educational and research offers.

Many within Liverpool deny there’s any significant problem with the current configuration – there are, after all, five specialist providers which are either “good” or “outstanding”. The city’s politics are also notoriously knotty, so plenty of skill and sensitivity will be needed to make this review count.