On the day briefing: next steps on aligning the work of NHS England and NHS Improvement.

NHS Improvement (NHSI) and NHS England (NHSE) have published a joint paper setting out proposals for aligning the work of the two organisations. This On The Day Briefing summaries the proposals, and our views on the proposals, which include:

• the creation of seven integrated (ie spanning both NHSI/NHSE) Regional Directors who will have full responsibility for the performance of all NHS organisations in their region. They will make decisions about how best to support and assure performance within their region as well as support the development and identity of local STPs and ICSs
• the creation of a new NHS Executive Group, co-chaired by the two CEOs and comprising membership of all national directors and Regional Directors from the two organisations. The Regional Directors will report to the two NHSE and NHSI CEOs and be full members of the national NHS Executive Group, with responsibility for working with the national directors to develop the overarching strategy and architecture for the NHS as well as translating that into operational plans
• the creation of a new NHS Assembly (provisional title) to ensure better engagement with the wider NHS and its users, with membership to include a wide range of statutory and non-statutory organisations.

 NHSI and NHSE will also align their core processes so that all interactions with the frontline NHS are conducted once. This includes establishing a single financial and operating planning process for the NHS, a single performance management process and the alignment of regulatory interventions, a single internal management process and a single process for establishing and reviewing national strategic programmes such as cancer, mental health and digital. The two bodies will establish a joined up and aligned approach to reporting and sharing information about the system.

There will however be some functions that remain distinct to each organisation. NHSI’s regulatory functions in relation to pricing, competition and patient choice, and its hosting of the Healthcare Safety and Investigation Branch, and NHSE’s responsibility for tariff currency development, commissioning of specialised services and primary care, and Emergency Preparedness, Resilience and Response (EPRR), will remain separate and distinct.

These proposals represent a significant change for NHSE, NHSI and the wider NHS. Over time they could herald a profound shift in the way the NHS is led at national and regional level and how trusts experience that leadership on the ground. We think they offer significant potential benefits, but there are also significant risks, and a lot depends on successful implementation and some major cultural/behavioural changes that are far from assured. We have set out the potential benefits, the risks and the critical success factors, as we see them, in this On The Day Briefing.