Exclusive: Carter recommendation dropped after NHS England intervention

A draft copy of the report has been leaked to HSJ which clearly stated a recommendation for a joint national clinical director for community services across both NHS England and NHS Improvement.

The draft report said: ”NHS England and NHS Improvement should jointly appoint a national clinical director for community services whose primary objective should be to set out clear and consistent ambitions around how the contribution of community health services can be better recognised, valued and specified.”

Speaking to HSJ, Lord Carter confirmed that he had agreed with NHS England to take the recommendation out but did so as he thought it was “perfectly logical” and argued there was no overall director for acute care. 

Several senior sources who saw the draft report told HSJ it was dropped at the request of NHS England and criticised the decision.

One source said the recommendation was taken out at the request of NHS England chief executive Simon Stevens, while another said the national commissioner opposed the recommendation as it did not want to “perpetuate historic models of care”. 

“It does beg the question how on earth is this huge agenda going to get implemented if there is no dedicated leadership to make it happen? Will it just be another wretched report that sits on the bookshelf?” the source said. 

A separate source said the move from NHS England was a “travesty”. 

The revelation follows the publication of the final report yesterday, which highlighted the “disparity” in national leadership between mental health and community health services but did not call for a joint national director. 

Calls for a national director for community services were also made in an unpublished five year forward view for community services, which was controversially dropped by NHS England. 

In an interview with HSJ in March, Bill Kirkup, who led an inquiry into service failings at Liverpool Community Health Trust, said he was “concerned about the cancelling of the [community] forward view.”

In the final version of his report Lord Carter said: “At a national level we were struck by the disparity in leadership capacity and focus from the Department of Health and Social Care, NHS England and NHS Improvement between mental health and community health services.

“For mental health services, there is now a clear ambition and a delivery programme set up to secure parity of esteem supported by strong leadership. This approach is making a real impact for patients.”

The document adds that the review found “gaps” in national work on how community services can meet the needs of the 21st century healthcare system and “no clear vision for how community health services can support the wider system”.

Within the review Lord Carter recommended that NHS England “codify” and share the learning of the new care models and successful vanguards in order to support community health services.

A spokesman from NHS England said: “Lord Carter’s report argues that the future for community health services is as part of integrated care systems linked much more closely to primary care on the one hand and hospital services on the other.

“Therefore, leadership arrangements must support that transition rather than reinforcing the current community services standalone fragmentation.”

A spokesman from NHS Improvement said: “As with any review the final report went through a number of iterations. The review makes a series of recommendations designed to strengthen community health services for patients and the taxpayer.”

Updated at 14:31 after HSJ recieved a comment from NHS Improvement