Published: 06/02/2003, Volume II3, No. 5841 Page 4 5

The four directorates of health and social care are to be abolished as the first part of a radical streamlining of the Department of Health, HSJ has learned.

The DoH will be reshaped into five functions: a chief executive's office co-ordinating policy and strategy; performance management (integrating the roles of the four directorates) to drive delivery; public health; corporate management and development; and the Modernisation Agency.

Although a 'slimming down' of central functions was promised in last year's NHS delivery plan, the sudden move now appears to be sparked by government concerns that it does not have a firm enough grip on the delivery agenda.

In a letter sent out to DoH employees last week, NHS chief executive Sir Nigel Crisp promised 'a completely remodelled department functioning no later than April 2004'.

HSJ sources said the first part of this - abolition of the four directorates, which have been live for just nine months - was likely to happen this Spring.

One strategic health authority chief executive said: 'To all intents and purposes, they will have ceased to function by July and ceased to exist by next April. It is an enormous shock in terms of the time, by about two to three years. It is devastating for the staff involved and it is disgraceful in my view.'

Mr Crisp has established a fourstrong change management team to buy in change management and personnel support for the transition. This consists of director of external and corporate affairs Hugh Taylor, chief inspector of social services Denise Platt, director of development Kate Barnard, and London director of health and social care John Bacon.

The DoH would not comment on the fate of the other three directors of health and social care - David Nicholson (Midlands and East) Ruth Carnall (South) and Peter Garland (North). None were available for comment.

Last April, the NHS delivery plan promised a slimmed-down DoH, with resources devolved from Whitehall 'to the lowest level possible' and day-to-day management of the NHS based in the 28 SHAs, which would become 'the local headquarters of the NHS'.

A senior government source said the overall intention was not only to shrink drastically the department, but also to alter its skill mix, by introducing more staff with implementation skills.

The department would then try to focus on the greatest priorities for the government.

He said SHAs would be asked to focus on performance management, service improvement and development and strategic planning, and predicted they could see as much as a 50 per cent increase in staff to cope with their growing workload.

NHS Confederation policy director Nigel Edwards said SHAs would face a precarious balance: 'The danger is of SHAs being perceived as part of the centre by people below them and not as part of the centre by the people above them.'

He was shocked at the way the changes had been announced: 'I do find it extraordinary that only eight months after they came into existence, it is necessary to do a further reorganisation. It is another reorganisation where the major planks are announced, but with no detail. This is disruptive and demoralising.'

But Mr Edwards welcomed the intention to have a beefed-up delivery unit. He said it would sit well with the drive for delivery in the public services being led by Cabinet secretary Sir Andrew Turnbull.

The letter from Mr Crisp says the changes are not finalised and are likely to be improved through discussion in the department.

He continued: 'I have asked directors to start discsussions with all their staff in the next couple of weeks and to follow this through with feedback via the February team briefing.'

'I would aim to circulate fully worked up proposals at the end of February. There are some predetermined deadlines for some of these changes which are important staging posts.My view is that we should plan to make organisational changes in stages but to have a completely remodelled department functioning no later than April 2004.'

And he added: 'I know that change can be unsettling and that everyone will be wondering how it affects them personally.'

A DoH spokesman said the directorates were not being abolished but integrated into the structure of the department. He added: 'It is not necessarily about closing offices. We may still have people out in the field.'

'We always said that directorates in the form in which they were created were a transitional way of working to manage this shifting the balance of power. We are not abolishing them or making them redundant.

He said: 'There is not an expectation that anyone will lose their job.

Overall, the work of the department is shrinking.We do not have to get rid of lots of people, but we might not replace individuals.'