What do leaders want from NHS Improvement? The view from Westminster

In a new Viewpoint publication, 'What do leaders want from NHS Improvement?', the Nuffield Trust and NHS Providers asked leaders from across the health service and other key positions in health care policy-making for their advice to the first holder of the new regulatory body NHS Improvement. In an extract from this publication, former Secretary of State for Health Stephen Dorrell presents his view. 

Jeremy Hunt’s announcement that he would appoint a single management team to take responsibility for Monitor and the Trust Development Authority set the ball rolling. But it left all the difficult questions unanswered.

How will the new team work? What will it do? Will it be a regulator? A system manager? A funder? On what terms? How will it relate to provider organisations? What is the future of the distinction between NHS trusts and foundation trusts? Will it seek legislative change? 

These are key questions which will shape future relationships throughout the health and care system – but the new team will have no choice but to answer them at the outset. Rising demand and growing deficits mean that there will simply not be time for quiet policy analysis; the new structures will be conceived in the crucible of crisis management. 

Against this background, decision-makers will need to be clear about what is important. 

First, NHS providers need to be better at changing their services and working with each other as well as third-party organisations to deliver joined-up care. This doesn’t mean a frenzy of structural change; it means a relentless focus on the needs of service users. In particular, it means connecting providers of the health care, social care, housing and other services that shape people’s lives. 

Second, NHS providers need to be more respectful of the opinions and priorities of individual users and collective commissioners who will increasingly look beyond the narrow confines of health care in their quest for better health outcomes.

Third, the new team needs to decide whether they are an improvement agency, a market regulator, or a provider regulator. There is an unreconciled conflict between these functions at the heart of the current legislation which creates unnecessary cost and confusion and needs to be resolved. 

Fourth, the new team also needs to decide whether to maintain the distinction between NHS trusts and NHS foundation trusts. Despite rhetoric suggesting otherwise, the recent reality has been a trend towards disempowerment of local management of all kinds within the NHS. This is a trend which needs to be reversed. 

Fifth, while no-one actively seeks new legislation, it seems likely that the new team will conclude that some of the inherited structures are simply not fit for purpose. If that happens, it is important that ministers address the issue head on – rather than relying on workarounds and inertia which undermine both efficiency and goodwill. 

Most importantly, the new team will need to show quickly that its primary focus is genuine service improvement. It is widely believed by both service users and professional staff that their interests have too often been the victim of a political fudge. 

Access to high-quality care services is inherently political, but management of the services themselves is not. NHS Improvement should be driven by a desire to ensure that services are shaped by the real needs and demands of those who rely on them.

The views expressed are the authors’ own, and do not necessarily represent those of the Nuffield Trust (or NHS Providers).