Exclusive: Stevens launches quick-fire NHS England 'structure' review

Simon Stevens has asked commissioning development director Rosamond Roughton and Karen Wheeler to lead the review.

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Ms Wheeler was recruited this month from the Department of Health to become the organisation’s director of transformation and corporate operations. He has asked them to report at the end of May

The main purpose of the review is to consider NHS England’s national structures, including whether to abolish its policy directorate, whose director Bill McCarthy is leaving the organisation. The review is not considering whether to reorganise its four regional and 27 area teams.

However, many directors of NHS England area teams are responding to the review with wider concerns, HSJ understands.

These worries centre on what they see as the organisation’s hierarchical way of working and its size, operating as it does with large national, regional and area team tiers and 5,500 staff.

Several area and national-level directors reported similar concerns to HSJ.

One area director said they and their teams had “very little autonomy to act”, leaving them feeling there was little value in their work.

The director described NHS England as “the most hierarchical organisation I have worked in”.

A large number of area directors were already seeking new jobs outside NHS England, several sources said.

Area directors have highlighted to the review that a very wide range of decisions currently must be referred for approval to its regional teams before being sent upwards to national directors.

One director said they hoped the review would also examine NHS England’s direct commissioning of specialised and primary care, including how CCGs could be given more responsibility.

HSJ’s quarterly surveys of CCG leaders have consistently highlighted concerns about their contact with NHS England, including in relation to direct commissioning and unclear decision making.

It is unclear whether the current review will respond to these concerns. However, it is understood that part of Ms Wheeler’s role is to examine how the organisation can work better.

Some senior staff are expecting Mr Stevens’ to gradually change its structure of four regional and 27 area teams. However, HSJ understands this will not take place as a response to the current review.

Mr Stevens has told staff there will be no immediate reorganisation but could be “incremental adjustments”, several sources said.

An NHS England spokesman said: “With NHS England a year old and the arrival of a new chief executive it is the right time to review how we work to make sure it is delivering for patients and getting best value for the taxpayer.

“This is a quick review of national functions so that we can refine our structure.”