Exclusive: Dalton steps down and Swindells under threat as Stevens takes over NHSI

NHS England chief executive Simon Stevens will assume leadership of both organisations, supported by a chief operating officer.

The move has seismic implications for the national running of the NHS, including Mr Stevens now becoming directly responsible for controlling the provider sector deficit as well as improving care through commissioning.

NHSE and NHSI began a process of working closer together last year and now hold some joint board meetings, with joint directors now appointed at national and local level.

The organisations indicated last year that the law prevented them appointing a single chair and chief executive across the two bodies. 

However, they now state that Mr Stevens is the “leader” of NHS Improvement, even though a new chief operating officer – to be appointed across the two organisations – will be formally designated as NHSI’s chief executive. 

The COO will report to Mr Stevens on most issues but “for regulatory purposes” to NHSI chair Baroness Dido Harding. 

The seven recently appointed joint regional directors, national emergency and elective care director Pauline Philip, and national director for improvement Hugh McCaughey will report to the COO.

Mr Dalton did not want to apply for the COO post, but Mr Swindells could still be moved to the new role. However, HSJ understands that the combined NHSE/I leadership would prefer a senior NHS leader from outside the organisations to do the job. Mr Swindells is likely to be placed at risk of redundancy over the next few weeks.

Guy’s and St Thomas’ Amanda Pritchard, Leeds Teaching Hospitals’ Julian Hartley and Central and North West London’s Claire Murdoch, as well as newly appointed London regional director Sir David Sloman and Ms Philip, are under consideration for the COO post.

NHSE/I say it will be advertised in the next few weeks.

NHSE/I have also made a series of other changes to the joint structure they proposed last year, to further integrate the two bodies. Ian Dodge will become joint strategy director. There will also be a shared single communications director, contrary to the previous proposal to keep two. The proposed post of chief provider strategy officer role has been scrapped.

Baroness Dido Harding will chair the NHSE/I’s joint delivery, quality and performance committee, while NHSE chair Lord David Prior will chair the joint strategy committee.

Mr Dalton joined NHSI in November 2017 after spending four months as the chief executive of Imperial College Healthcare Trust, following three years as president of global government and health for BT Global Services. He had previously been deputy chief executive and chief operating officer of the NHS Commissioning Board (now NHS England), and before that managing director of provider development at the Department of Health.

In a statement to staff Mr Dalton said: “I… feel a degree of personal regret that I will not be part of the joint organisation that will turn the NHS long-term plan into action, but it is the right decision to make this change at this time.”

Mr Dalton will continue to work at NHSI during the handover the chief operating officer.

Mr Swindells came to NHS England in December 2015 from the IT firm Cerner where he was based in the US. Before that he worked at the Department of Health as chief information officer, as chief executive of Royal Surrey Hospital, and for the consultancy Tribal. He has led on technology at NHS England, as well as performance and service transformation, and leadership of many of the IT functions are due to transfer to the new “NHSX” created by the health secretary Matt Hancock.

Chris Hopson, chief executive of NHS Providers, said: “If the intention is to bring NHS England and NHS Improvement closer together, it is logical to move to a single senior leadership structure across both organisations, led by a single chief executive.

“Ian Dalton has shown the importance of senior arms length body leaders understanding the needs of those responsible for frontline service delivery and supporting them to provide outstanding patient care… Provider leaders will want to thank Ian for the excellent work he has done and support he has given. They will also wish him well for the future.”