My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Q. What are the two things that could survive a nuclear holocaust?

Filed Under (Localities, National Commissioning Board, Regional Health Authorities) by Paul on 26-04-2012

A. Cockroaches and Regional Health Authorities.

I must right away give acknowledgement to the author of this joke. It comes from Nigel Edwards who worked for the NHS Confederation for a long time and has seen his fair share of NHS reorganisations.

The point it makes is that some NHS reorganisations are specifically aimed at the complete destruction of its regional tier, but as the mushroom cloud clears, there they are – regional health authorities under a new guise, doing what they always do.

People like Nigel who have been around reorganisations for a long term recognise that however much power seems to be deployed against regional health authorities, they simply keep on surviving. The past 18 months has seen another lesson in their longevity.

This battle over NHS reform started with the White Paper ‘Liberating the NHS’ which begged the question, “From whom is the NHS being liberated?” Insofar as anyone could understand what the Government was talking about, most people’s answer was the Strategic Health Authorities (SHAs).

The promise of the White Paper was that the NHS would be liberated from SHAs and that this would apply especially to the new GP led commissioning organisations.

Of course the resulting Bill then meandered through several organisational theories, many of which contradicted the original liberating notion.

Now we can see that the liberating Health and Social Care Act has created the most powerful national organisation that the NHS has ever had – the National Commissioning Board. This board, to everyone’s complete surprise, will have four offices in the regions – in London, the South, the Midlands and the North.

It is however very important though that no one goes around saying that these are “Regional Offices” (in capital letters). Not at all. Let’s be quite clear. The Regional Offices have been done away with. It’s just that the four new offices of the NCB happen to be in the regions. But they are NOT Regional Offices.

I’m pleased that point is clear.

But I may be being unfair. Perhaps these organisations will be very different.

We will now have an opportunity to find out. It seems very likely that at least 3 out of the 4 interim CEOs of the old SHAs/new Regions of the NCB will be leaving their jobs before they are appointed into the new organisations.

This gives the new organisation the opportunity to demonstrate that it believes it is a new and different organisation by appointing different kinds of people from those who used to run SHAs.

It would be useful if these new regional leaders of the National Commissioning Board had ever run an organisation that commissions health care. Given the word ‘commissioning’ is in the title it doesn’t seem too much to ask that the regional leads should have run some kind of commissioning organisation.

I realise that for the NHS this would be completely counter-cultural since for them the really important people have all run hospitals.

But now, in 2012, the NHS can draw on the experience of at least 150 PCT CEOs. They have run organisations responsible to the DH for the commissioning of NHS care.  Some of these were very good at commissioning and could play a role in creating a new organisation that (and I realise I am being naive here) – actually knows how to commission.

Will any of these people get these powerful commissioning jobs, or will they instead be handed out to people who have essentially run hospitals before working in the SHAs?

Will Regional Health Authorities survive this attack as they have all others?


3 Responses to “Q. What are the two things that could survive a nuclear holocaust?”

  1. I think the main candidates for all four regional director posts – all of which are up for grabs – have not recently been in senior hospital posts. That includes current SHA staff (in fact some leading PCT cluster chief executives may have been hospital bosses more recently?)

    There is a question though about how much they will actually be allowed to commission, or take a lead on commissioning, given the pressure to step back and let CCGs take a lead. See Ruth Carnall’s comments –

    Also a question whether over time the NHSCB will scrap the 4 regional tiers (1-4-50) and move to about 30 stronger local offices (1-30).


  2. ‘It seems very likely that at least 3 out of the 4 interim CEOs of the old SHAs/new Regions of the NCB will be leaving their jobs before they are appointed into the new organisations.’….collecting some heft severance payments en route, no doubt?

  3. My fear is that the new roles will be filled by the 150 or so CEO’s circulating the system. We have seen this at all levels in the system. This is an unparalleled opportunity to raise the overall commissioning and leadership competence but ‘recycling’ people in the system may not be the right move. Not to mention people on CE salary doing Director level jobs!

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