Barclay orders ICSs to publish ‘organograms’ by 6 January

In a letter to integrated care system chairs and chief executive officers, seen by HSJ, health and social care secretary Steve Barclay said the organograms should show team numbers, cost and grade for each organisation and be published by 6 January.

The letter comes after the health and social care secretary pressed the Department of Health and Social Care’s arm’s-length bodies, including NHS England, to issue organograms in the autumn. Mr Barclay’s letter said the previous documents had helped health leaders “see more clearly where resource is spent at the centre” and started “helpful conversations about where our priorities and resources are aligned”.

However, the letter has prompted warnings the diagrams would be “stripped of all context” and used to fuel a “cheap attack” on NHS management. The NHSE release prompted a Daily Telegraph report headlined “NHS England employs more than 400 bureaucrats on over £100k a year”.

There has been increasing speculation that ICSs, which are not even a year old, will be ordered to cut running costs. NHSE CEO Amanda Pritchard has said ICSs will need to “rationalise roles” and use “economies of scale” but no firm directions have been issued.

Some areas are already planning a more streamlined operation or have launched voluntary redundancy schemes, in part because some have inherited more staff than they want from the clinical commissioning groups they replaced.

In his letter, Mr Barclay wrote: ”It is important that all parts of the health and care system, both national and local, demonstrate transparency, so the public and those on the frontline understand how money is spent – and make the connections needed between different organisations as they work increasingly as systems, rather than as individual organisations.

“As a result, I am asking [NHSE] to work with each [integrated care board] to produce an anonymised, searchable organogram by 6 January 2023. The organogram should show the structure of teams within the ICB, including the number of staff in each team and at each grade and the total cost per team.

“This will help the public to understand how integrated care boards are structured including which roles report to others and also highlight the work that you are doing to develop integrated care.”

Mr Barclay has spoken repeatedly about wanting to reduce staffing numbers at organisations not providing direct patient care, and has previously said ICSs and commissioning support units collectively employ 32,000 people at a cost of nearly £2bn.

The DHSC sets an annual limit the NHS is allowed to spend on administration, and the government may look to squeeze this next year.

One ICS leader told HSJ the letter was a “useful” challenge, adding: “ICBs are not CCGs mark two.” Another said the move would help identify duplication and suggested it would be useful to extend the exercise to trusts and foundation trusts. However, one CEO said it would be hard to quickly reduce ICB staffing without also facing large redundancy bills.

And Sarah Walter, director of the NHS Confederation’s ICS network, warned: “There is a risk that a misleading picture is presented when the data is aggregated across the country. In effect, the current organograms will only be a temporary snapshot of a changing situation so care will be needed when using the data.

“Our members are all for transparency, but the danger of this latest government requirement is that the presentation and interpretation of these structure charts will be stripped of all context and used as a cheap attack on NHS management.

“Given the government’s reforms that introduced [ICSs] were widely supported, it would be a retrograde move if this exercise was used to undermine public confidence in local systems just as they are starting to make progress.”

She added the DHSC had guaranteed CCG staff would be transferred over to ICSs and many were already reviewing staffing levels.

Meanwhile, Patricia Hewitt’s rapid review of ICSs is expected to produce interim findings later this week, but it is unclear if they will be published. The former Labour health secretary was asked to consider greater control for local leaders and a slimmed-down set of national targets.