Daily Insight: Meet the new boss (same as the old boss)

NHS England has promised a “lighter touch” approach to some trust mergers and acquisitions – but a close read of new rules makes it clear they are still in charge.

Organisational changes were constrained by anti-competition measures brought in by the Lansley act, but have gathered pace in recent years, with many trusts adopting a halfway house of sharing chairs or CEOs.

The bar has now been lowered further in guidance published this week by NHSE. Head office has dropped an initial requirement for trusts to demonstrate that mergers would bring a “step change” in quality, instead opting for “deliverable” benefits to patients and the public “materially outweigh[ing]” the costs.

Any changes will have to be revenue neutral or better, with financial tests for a project focusing on whether it will deliver savings within a three-year period.

Another area in which ambitions appear to have been rolled back is quality – stabilising, rather than improving, declining performance would also be an acceptable reason to merge.

Of course, NHSE will play a key role in weighing those assumptions, and makes it clear it retains the power to block a merger going ahead.

Meet the new boss, part two

Wednesday night’s publication of NHSE’s operating framework has made it clear that not all integrated care boards will hold the lead performance management role for a majority of their member trusts. 

The document says ICS integrated care boards will provide “first line oversight of health providers across the ICS to oversee performance and contribution to overarching plans”. 

But NHSE will “lead on support for organisations in segmentation three and four of our oversight framework” because only NHSE has the legal power to intervene, it said.

The pre-existing system oversight framework, known as SOF, rates trusts from one (best) to four (worst) based on a range of measures and judgements.

NHSE told HSJ that, for trusts rated four, the national NHSE team would lead on “oversight, support and intervention”, with region and ICB input. There are 16 trusts rated four. For those rated three (currently 66 trusts), the regional team will lead, with input from the ICB, NHSE said.

It means that some ICBs will be the lead for oversight/intervention for only a minority of their member trusts, because a majority are rated three or four — and in some case none. A majority of trusts are rated three or four in the Black Country, Nottingham and Nottinghamshire, Devon and Northamptonshire, for example. In Cornwall, both trusts are rated three.