Thursday’s announcement on the future size of NHS England after its merger with NHS Digital and Health Education England went largely unnoticed as Boris Johnson resigned on the same day. The board has indicated that by April 2024 the newly merged body will be 30–40% smaller than the current combined workforce.
I’m told the timing of the announcement was not intentional. But it certainly heightened the concern of many members, as did what some members felt was senior staff reading from scripts. And it’s also concerning that we have a figure for job cuts before the design of work, involving the staff themselves, has been done.
MiP are rolling up our sleeves and will work in partnership with employers – and hold them to the promises made about how change will be managed. Major organisational change always throws up a huge range of technical problems to solve. But it’s the impact on a person’s wellbeing that must stay front and centre. We have already contacted members who may be affected and will be writing to them again this week.
These proposed changes don’t just matter for NHS staff employed nationally and regionally. Three areas strike me as important as for everyone.
First, I have already seen people elsewhere in the NHS system shrugging their shoulders or even rubbing their hands a bit. The relationship between NHS England and the rest of the system is imperfect and needs work. But the hope that this move will see a pendulum swing from national to local is misguided. For as long as the NHS is led by a national politician and funded from central taxation it will need a strong centre. The point is to get the upside of both strong national direction and strong local autonomy. Either/or is not the answer.
Second, the NHS spends 2p in the pound on administration. While a debate is needed about where best to put its management resources, we need an overall cut to those management resources like a hole in the head. ICB leaders have pointed out the important work regional teams across the three bodies do in support of local systems. We need to keep the skills and experience of national and regional staff in the NHS, and a major objective of the change process should be preserving the overall headcount of managerial and specialist staff across the NHS as much as possible.
Third, this change will be an important chance to show how to do it the right way. Both the what and the how. For many MiP members the recent creation of ICBs was not a great experience and there has to be a better way to handle structural change. This is also the first test of Messenger’s recommendations for a proper career structure for NHS management and increasing the diversity of management. If these recommendations don’t influence the NHS England changes then the first test will have been a bitterly disappointing failure.
- Jon Restell is chief executive of Managers in Partnership.