On 1 March, NHS Improvement chief executive Ian Dalton announced his decision to leave his role in a letter to staff.
Mr Dalton explained that he, NHS England chief executive Simon Stevens and the NHS Improvement and NHS England boards had jointly agreed that a model with two chief executives was not the best way forward for the two organisations, or for leadership of the NHS.
Mr Dalton said a new role of chief operating officer/ NHS improvement chief executive will be introduced, with the new person expected to report directly to Simon Stevens.
He added that this role will ‘be quite different in scope and nature’ from the one he has held for the past 18 months and that he had therefore decided to leave his post.
NHS England and NHS Improvement had already started working more closely together, a change that begun in March last year.
However, this move is seen by many as moving one step closer to a full merger of the two organisations.
NHS Confederation chief executive Niall Dickson
— Niall Dickson (@NHSC_Niall) March 1, 2019
Commenting, NHS Confederation chief executive Niall Dickson said: ‘The national leadership of the NHS needs to have a clear and single view about the future direction for the service. This has not always been the case, so moving to one integrated team, led by Simon Stevens, has to be the right move.
He added: ‘At the same time, we must make sure the new combined organisation is an enabling one which understands, empowers and works to support frontline leaders. The NHS long term plan will be delivered by letting local systems lead not by more centralisation and control.
‘Our thanks go to Ian Dalton who has handled a difficult brief and supported our provider trust members during what has been a turbulent period.’
NHS Providers chief executive Chris Hopson
NHS Providers chief executive Chris Hopson said: ‘If the intention is to bring NHS England and NHS Improvement closer together, it is logical to move to a single senior leadership structure across both organisations, led by a single chief executive.
‘Ian Dalton has shown the importance of senior arm’s length body leaders understanding the needs of those responsible for frontline service delivery and supporting them to provide outstanding patient care.
‘Ian’s work to secure a realistic financial settlement for providers in 2019/20, create a more sustainable financial architecture and develop an implementation framework for the long term plan have all been good examples of the arm’s length body support the frontline needs.
‘Provider leaders will want to thank Ian for the excellent work he has done and support he has given. They will also wish him well for the future.’
NHS Clinical Commissioners chief executive Julie Wood
NHS Clinical Commissioners chief executive Julie Wood said: ‘We are optimistic that closer working between NHS England and NHS Improvement, and shared leadership across the two organisations, will go some way to help commissioners work more collaboratively with their provider colleagues.
‘Having two separate assurers/regulators in NHS England and NHS Improvement has at times meant inconsistent messages for clinical commissioners and providers alike.
‘Our members have told us that aligned regulation and joint messages coming from these regulators may help with their own efforts to integrate so this seems like a step in the right direction.
‘However, from our perspective it is vital that with any shared roles there are still clear responsibilities, both nationally and locally, to maintain the unique perspective of clinical commissioners.’
Nuffield Trust director of strategy Helen Buckingham
Nuffield Trust director of strategy Helen Buckingham said: ‘A unified structure is a good thing, and gives leaders nowhere to hide on the money. But I do have a few concerns.
‘There are still plenty of other players on the pitch, such as Health Education England, NHS Digital, NHSX, Public Health England.
‘Too much change at this level could look like fiddling at a national level while out there Rome is burning. NHS England and Improvement were just starting to make appointments to the levels below the executive tier – these new steps alongside the change at a chief executive level are likely to add delays to this.
‘There are still a lot of unanswered questions about how the new aligned organisation is actually going to work which don’t go away through the deletion of one CEO – the presence of two chairs remains interesting for a start.
‘An organogram and a single set of performance data only take you so far.’
West Yorkshire and Harrogate Health and Care Partnership lead Rob Webster
Rob Webster, chief executive for South West Yorkshire Partnership NHS Foundation Trust and chief executive lead for West Yorkshire and Harrogate Health and Care Partnership said:
‘Closer working between NHS Improvement and NHS England is very welcome. As we develop integrated care systems (ICSs) it is important that our regulators are organised in ways that support ICSs to be successful.
‘I’d like to wish Ian Dalton well in the next stage of his career. He has played a significant role in the NHS for decades and deserves our thanks.’