The announcement of the major reorganisation of Arm’s Length Bodies (ALB) with the merger of HEE, NHSX and NHSD into NHS England/Improvement may not be a great surprise in terms of its content but it certainly is in terms of its timing and presentation.
The problem with all major restructurings is that, inevitably, they distract organisations from their core task, which for these ALBs is supporting the NHS. Staff will be anxious about their jobs, good people will leave and focus will be lost. While the rationale for these changes is understandable it has to be asked whether the extent of problems in coordination and collaboration across the national bodies currently actually warrants the level of overall disruption that will undoubtedly occur.
In terms of the merger of HEE into NHSE/I, we absolutely recognise the importance of ensuring that workforce, service and financial planning are part of a single process – and there have been real steps forward in this area in recent years. We have also shared HEE’s frustrations in being consistently excluded from the uplifts received by NHSE/I. If a merger addresses these issues, it will be a positive step.
However, there are also threats. Part of the reason for the establishment of HEE as a separate body was to ensure that training and education budgets were effectively ring fenced and protected. History has too many examples of education budgets being raided at national and regional level to support service provision. That must be insured against.
Additionally, HEE was able to provide an authoritative voice on workforce independent from NHSE and that has had real value. The ability to speak openly on workforce issues must not be lost.
In terms of NHS Digital and NHSX , the Academy and its member colleges and faculties do not have a specific policy view on the merits or otherwise of the proposal to bring these functions back into NHSE/I. However, as stated above, any benefits will have to be weighed against the disruption that will be caused.
In conclusion the Academy is concerned that at a time when the NHS is facing the worst emergency and urgent care pressures on record and that rapid elective recovery from COVID-19 is far from certain, there is a real danger that this becomes simply another distraction for those who could otherwise be assisting the service and NHS staff deal with the very real problems of today.
23 November 2021
© 2023 Academy of Medical Royal Colleges.