Trust chiefs complain to Hancock over his ‘restructure on a whim’

The health secretary is understood to want an integrated care system to cover the whole of the county of Essex – a move supported by Essex County Council. This would be in line with the government’s health and social care paper, published last month, which says ICS and local authority boundaries should be coterminous. At present many, including several in the East of England, are not.

But HSJ understands a group of influential NHS leaders and some of the local MPs are warning Mr Hancock this would be a “disaster” and cause unnecessary upheaval and disruption.

They are lobbying to retain the existing boundaries, which sees Essex divided across three ICSs: Suffolk and North Essex, Mid and South Essex, and Hertfordshire and West Essex.

Two senior local NHS figures expressed their concerns to HSJ. One source said: “No one in the NHS locally, regionally or nationally want this to happen. It is entirely driven by Hancock for reasons no one understands.

“From an ICS point of view it’s a disaster, I understand [Sir Simon] Stevens doesn’t want it to happen either, it is entirely on the whim of the secretary of state. We have been firmly told [Hancock] is not going to change his mind, the only chance of this changing is a change in the secretary of state.”

HSJ understands a number of senior NHS leaders, including Nick Hulme, chief executive of East Suffolk and North Essex FT, and Mid and South Essex FT chief Clare Panniker, have signed a letter to Mr Hancock expressing their concerns.

A number of MPs – including senior Conservative Bernard Jenkin, MP for Harwich and North Essex – have also expressed their concerns.

Mr Jenkin, chair of the influential Commons liaison committee, told HSJ: “Larger business units [are required in the NHS] because of the shortage of capable leaders… The solution may well be a compromise… A Suffolk and Essex health boundary may well be the answer.

“That reduces the number of relationships which need to be managed between social care and the NHS and also provides substantial scale for the NHS which would be lacking in a Suffolk-only boundary.

“The real problem in the NHS, the reason why a plethora of CCGs have failed, is because there is a dearth of capable leaders in the NHS. The NHS has taken far too little care over the development of its leaders – and that’s the real problem.

“There is a case for larger business units because of the shortage of capable leaders.”

NHSE itself has also, in recent years, considered pushing for ICS to cover larger geographical areas. It is unclear whether Hertfordshire without West Essex, or Suffolk (part of which, Waveney, is currently in an ICS with Norfolk), would be large enough to be a standalone ICSs. A division would also cause problems for East Suffolk and North Essex Foundation Trust, which would be split across the two ICS.

James Halden, a Conservative councillor for Thurrock, a unitary authority which would also be covered by a proposed Essex ICS, and chair of its health and wellbeing board, has warned a boundary shake-up could hinder the current Mid and South Essex ICS in pressing on with getting through its post-covid care backlog.

Essex County Council told HSJ in a statement: “Essex is currently the only area (as far as we are aware) where our population is split across three ICS systems. ECC has not been consulted on what this means for Essex but would welcome confirmation that the population of Essex would be within a single integrated care system.

“ECC genuinely believes that coterminosity would provide the strongest and most enduring basis for the NHS, local government and other partners such as Essex police and fire to work together on improving health outcomes over the next decade, ensuring opportunities to align agendas for adults and children’s social care, education and for public health (as well as other local government services) with NHS commissioning.

“We appreciate, however, that any boundary change does cause inconvenience for NHS partner organisations who have been developing plans on footprints around acute hospital flows.”

The Department of Health and Social Care said in a statement: “Following discussions between the [DHSC] and NHS England and NHS Improvement, [ICS] boundaries which are not aligned with local authority boundaries are being reviewed to ensure future arrangements can support the most effective partnership working between the NHS and local government.”

HSJ also approached the three Essex ICSs for comment.