Conclusion

As policymakers and ministers work through implementation of a new NHS operating model, there is much to consider. 

With regulatory powers previously held at arm’s length from government potentially returning directly to the Secretary of State and DHSC (and enacted by the regions), there is a risk that local accountability reduces and central control is greatly increased. This is despite the 10YHP stating its intentions are to devolve power and control.

The earning and restricting of autonomy proposed and potential authorisation/deauthorisation brings additional risks and raises the question as to whether organisational autonomy is seen as a driver of organisational effectiveness, or a reward for good performance. 

In short, much more needs to be done to clarify the policy direction. Legislators and implementers of the 10YHP will need to consider to what extent provider autonomy is likely to be meaningful within the legal, regulatory, and performance management frameworks currently proposed. 

There also remain multiple questions about IHOs: not only about what form they will take, but also whether evidence supports their emerging place and status within the provider landscape and at the heart of delivering the 10YHP’s aims. 

NHS Providers and trust leaders are committed to achieving the shifts outlined in the 10YHP. As the policy contained in the plan is worked through to implementation, it is vital that tensions are recognised, policy intent clarified, and the specifics committed to in the plan are interrogated and if necessary redrawn so that its important ambitions for the NHS can be achieved.