North by North West: Why two ICS bosses quit

In a surprise development last week, the chair and chief officer of the newly-christened Cheshire and Merseyside Integrated Care System announced they were quitting — saying the job had morphed into something they hadn’t signed up for.

After further enquiries by NxNW, Alan Yates and Jackie Bene have since explained their decision in more detail, saying it had not been clear when they were appointed that ICSs would become full statutory organisations and subsume the functions of clinical commissioning groups.

In a joint statement, they said: “The posts [pre-pandemic] were partnership posts working on a population health and inequalities agenda through integration… Our vision was for a relatively small organisation supporting statutory bodies to work collaboratively, and more effectively.

“We have both been accountable officers for significant parts of our careers [and] we both took these posts on a part-time basis and for a limited term.”

The pair felt there was still a prospect for this sort of model as late as November 2020, when NHS England launched a consultation on ICSs.

This included one option of a joint board which “binds together the current statutory organisations” and did not take on commissioning functions, although the consultation also made it pretty clear this was not the preferred option.

When the government white paper was published in February, it confirmed ICSs would instead become full statutory bodies and subsume the functions of CCGs (with an added complexity of there needing to be two different boards).

Mr Yates and Ms Bene have no complaints about that decision, saying it was “properly made and consistent with consultation”, but they said it ultimately “changed the nature of the post of chair and chief officer substantially”.

The old divide

Although accepting of that, other senior people in the system also point to tensions between the NHS and local authorities which have flared up again in recent months.

The original sustainability and transformation partnership, headed by Alder Hey chief executive Louise Shepherd, had poor relationships with local authorities, partly due to wild and generalised suspicions around STPs being secret mechanisms for privatisation, but also because of a lack of engagement.

First through Alan Gibson and Mel Pickup (the previous chair/executive lead), and then Alan Yates and Jackie Bene, the STP spent the next three years trying to engage and build up trust with local councils.

Some in the NHS think they overcompensated — giving local authorities an inflated sense of what their role would be, in terms of holding budgets, making key appointments, and making decisions about funding allocations.

A recent job advert for an executive director posted by Knowsley Council is understood to have infuriated many on the NHS side, after it included in the job description: “Oversee the transfer of responsibilities from Knowsley Clinical Commissioning Group to the council.”

As the white paper makes clear, CCG responsibilities are to be subsumed by ICS NHS boards, not by local councils.

One well-placed source in the system told NxNW: “What’s happened is some of the local authorities feel they were promised all sorts of things, in terms of control of funding and so on, and so they’ve gone out and recruited to these sorts of roles, which has then alienated the NHS side.

“Some of the councils now feel the ICS has been oversold to them… and it’s caused an unnecessary power struggle.”

NHS-council tensions are certainly not unique to Cheshire and Merseyside, and will surely flare up in other systems over the next year as ICS structures are thrashed out.

There will always be a central and age-old difficulty — as lamented by Jon Rouse when he stood down from the ICS in Greater Manchester — that shifting resources into council-run population health measures such as housing, early years, or prevention, is likely conflicting with the need to meet NHS constitutional standards.

John Bennett, an independent consultant who has advised many of the organisations in C&M, said: “The challenge facing all ICSs is balancing population health priorities alongside the NHS’ continued focus on targets and hospital activity.

“Cheshire and Merseyside has progressed and pushed the boundaries of place-based working, resource allocation and control of decision-making, further than most health and care systems in England.”

Asked about the short-lived tenures of Mr Yates and Ms Bene, the source within Cheshire and Merseyside said: “I’m pretty sure anyone in the know understood that ICSs were going to be statutory organisations. So, it either looks very naïve, or things just got too difficult.”

Manchester lobbying up

North Manchester General Hospital is among the highest profile of Boris Johnson’s “40 new hospitals”, having recently been elevated to the priority list for national capital funding.

But interesting plans are also being hatched for major development at Wythenshawe Hospital in the south of the city, using a very different funding model.

There is quite a bit of vacant council and NHS-owned land around the site, and Manchester University Foundation Trust hopes it can generate funding from commercial partners to help pay for gradual redevelopment over 15 years.

However, this would still require a funding “mechanism” to be agreed with the Treasury, so the trust and its partners are again in lobbying mode.

Local MP Mike Kane told Parliament last week: “Wythenshawe Hospital’s strategic regeneration framework sets out a vision for the campus, which will be supported by a world-class research and innovation business park alongside a redeveloped, modern and inviting hospital.

“Great companies such as Chiesi [Italian pharma giant] and Hologic [US med-tech] are already based in my constituency.

“The cherry on top of this masterplan is that it will require no funds from Treasury. In fact, it can be funded on site with the correct commercial partners… We need a mechanism from the Treasury to allow the vision to be realised.”