• “Five or six” STPs looking at significant organisational restructure
  • Arm’s length bodies looking to devolve resource to well developed STPs
  • “Reboot” of STPs is required to improve engagement

The chief executive of NHS Improvement has said some regional health systems could “change their governance mechanisms” to create a single entity to run the NHS in their area.

Jim Mackey

Jim Mackey confed 2016

Speaking at the NHS Providers annual conference in Birmingham today he called on leaders to rationalise corporate and backoffice overheads, which he described as “enormous”.

He also revealed there would be a “reboot” of the STP process in the new year, focused on improving communications with staff and communities.

Mr Mackey said: “We will not have 44 SHAs at the end of this [STP] process.

“There are a few STPs who are keen to change their governance mechanisms, less than 10, maybe five or six.

“Most STPs will still be a collective planning development strategic forum rather than an entity that is actually going to run the system. So in that context we need to think about accountability and who is responsible for the money and what decisions are made in institutions and which are made at a system level.”

This could lead to a major rationalisation of back office costs, he said: “If you are in a well developed STP where everyone is together and you have a good plan, you’ve got comfort with each other and trust we’ll be working through now to what extent can we devolve the arm’s length body resource to you, the ability to harness all the back office costs in that area, CCG, CSU costs and corporate back office costs in providers which you all know in each community is absolutely huge.”

“If we can get to a point where in an STP area you want to take that off us, you want to rationalise it and turn it into money to invest in patient care, fantastic. We haven’t worked out how to do it yet, there will still have to be some accountability, but let’s slim it down.

“In some places that looks like an ACO or a devo thing but really go after the local ownership of the system because the system is ready to give you the system back.”

Mr Mackey said “universally” people would accept that the STP process has been useful for “breaking us out of individual silos” and working across whole systems.

But, he said, over the year the “exam question” that STPs were intended to answer has changed. “We started off answering the French exam in the spring and it’s now an advanced maths question. So there’s a bit of a reboot required.”

He said there has been “deep discomfort about the inability to have a conversation” publicly about STPs, and that this process would begin in the new year after the final STPs were published.

Mr Mackey indicated the Treasury was also asking the NHS to reduce backoffice costs. The Treasury “should rightly say rationalise your overhead because it’s enormous, and it is”, he said.

Mackey: STPs will 'reboot' and help cut 'enormous' overheads