The core functions of the NHS regional teams have been revealed in a new regional model blueprint.
Under the plans, the seven regions in England will keep their existing footprints but will have an expanded role following the announcement of cuts to ICBs and NHS England.
These additional roles include a performance management element, which is no longer the responsibility of ICBs.
There will also be a new regional governance model, with a chief executive and non-executive chair in each region.
The blueprint has set out three core functions for regions:
- Regional strategic leadership,
- Performance management and oversight,
- Improvement and intervention.
Within strategic leadership, regions will oversee ICB reform and transformation and identify the candidates for integrated health organisation development. They will also provide oversight of the Health Innovation Networks in their regions.
In their performance management roles, regions will provide real-time operational oversight of provider performance, apart from primary care providers, and ICB performance and commissioning, as well as oversight of ICB boards. Primary care oversight will sit with ICBs.
For improvement, support and intervention, regions will be asked to have oversight and coordinate improvement of best practice, supporting development in ICBs as well as providers. They will also support ICBs and the development of their strategic commissioning capability.
The blueprint added that as part of the Department of Health and Social Care (DHSC), after NHS England’s abolition, the teams will have a wider remit than they do now. NHS Providers said this could include functions not covered by the NHS, such as social care and public health.
NHS Providers added that it is ‘essential’ that the final operating model is ‘well-worked through’ so it can deliver the three ‘critical aspects’ set out in the blueprint. These are:
- Vertical coherence between parts of the system – with clarity about purpose, functions and accountability, and no duplication across DHSC, DHSC regions and ICBs.
- Horizontal coherence – aligned functions, capabilities and enablers across the system.
- And the right culture, interfaces and ways of working.
NHS Providers said there was an ‘overarching question’ on whether regions operate in service of the commissioners and providers, or vice versa.
‘The tensions between functions – oversight and support, performance management and coordinating transformation – that have at times hindered NHSE regions’ effectiveness remain embedded in this blueprint as it stands,’ it said.
‘A new role of ‘regional chair’ is proposed, charged with both support for trust and ICB NEDs and oversight of their capability. The use of “chair” for this role, and for the regional “chief executive” role, is confusing, since the DHSC regions are proposed to be only part of DHSC, not separate organisations, and there is no mention of them having a board. It is also unclear who would appoint a regional chair and to whom they would be accountable. Legislators are likely to take an interest in this when the health Bill is introduced.’
It added: ‘Mixing support and oversight functions within the role of both the regional leaders is unlikely to lead to either effective support or the creation of open cultures.’
NHS Providers called for more work several aspects of the blueprint, including on the degree of standardisation introduced by regions, the role and accountability of strategic authority mayors, and the potential duplication between functions of ICBs and regional teams, such as digital leadership.
The blueprint has also delayed delegation of Section 7A public health functions, such as screening, immunisations and child health information systems, which NHS England set out an aim to ‘potentially delegate’ to ICBs from April 2024.
NHS Confederation said this delay ‘postpones consolidation of commissioning budgets at system level which is a key part of shifting resources from just treating illness to prevention’.
It added: ‘This new enlarged regional role comes as ICBs are reducing the size of their executive teams and providers are cutting their corporate spending. While there is a clear logic to this expanded role, given ICBs’ capacity cut will be back by 50% and forthcoming cuts to providers’ corporate capacity, it is not clear how this enlarged governance tier aligns with the blueprint’s commitment “to deliver a more… devolved health service and push power out to places, providers and patients”.
‘Regions will likely have to deliver this expanded remit with fewer staff, given the government’s commitment to reduce the combined headcount of DHSC and NHS England by 50 per cent overall (saving £500 million) as the two central bodies and integrated. It is not clear that regional teams will have the capacity to deliver all these functions effectively, putting them in a difficult position. Future iterations of the blueprint will need to wrestle with some of these questions.’
It comes as six new ICBs will be in place by April 2026, abolishing 12 existing ICBs. This is part of the new ICB landscape, as ICBs make plans to reduce their operating costs by 50%.
