NHS Improvement, the new health watchdog launched in February, combines the duties of NHS Foundation Trust supervisory body Monitor and NHS trust regulator the Trust Development Authority (TDA). Health Adviser examines what key influencers want from the new organisation.

Over the next few months, NHS Improvement’s new Chief Executive, former Northumbria Healthcare Foundation Trust boss Jim Mackey, will set out how the new organisation will “stand shoulder to shoulder with the service” at a critical time where major service redesign is a priority in the face of rising deficits and declining performance. But given a choice, what do senior NHS personnel want from the regulator? 

Richard Murray, Director of Policy at think tank the Kings Fund, says improving financial and clinical performance “cannot be done by setting lots more national targets, nor by ever tighter regulation”.

“Evidence tells us that the way to bring about sustained improvements in the quality of care is to provide freedoms to local leaders and their organisations, giving them the tools and space to allow them to improve. This requires a supportive national framework but not any extension of central control.” 
   
This is echoed by Jennifer Dixon, Chief Executive of the Health Foundation, who believes “effective improvement can’t be imposed centrally, but must be designed and owned locally”.

And, in terms of use of quality improvement techniques, such as lean, Six Sigma and Total Quality Management, “it doesn’t matter which one, as long as it is used systematically,” she adds.

The immediate task will be to “gain control of the financial situation and establish discipline”, agree Chris Hopson, NHS Providers Chief Executive and Nigel Edwards, Nuffield Trust Chief Executive. 

“This will require the ability to distinguish between the different reasons for organisations being in financial deficit – are there issues inside the organisation that need addressing, problems in the local health and social care economy or fundamental questions about the sustainability and viability of the whole system?”

Hopson and Edwards also call for some form of regional ‘referee’ to unblock and enable where local participants cannot agree or make sufficient progress on their own. 

Sarah-Jane Marsh, Chief Executive of Birmingham Children’s Hospital NHS Foundation Trust wants regulatory frameworks aligned. “We need one definition of what ‘good’ looks like, and to be held to account for that. At the moment, no chief executive really knows the ‘rules of the game’,” she says.

Dr Amanda Doyle and Dr Steve Kell, co-chairs of NHS Clinical Commissioners want a regulator that “supports rather than stifles” innovation.

And they want fast action. “Decisions over new internal structures and processes, such as the 2016/17 tariff, cannot be allowed to take precedence over determining pressing issues, [as these] impact on the whole of the health system.”

Former Health Secretary, Stephen Dorrell – now a healthcare and public sector senior adviser to consultants KPMG – says 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”.

Finally, Jeremy Taylor, Chief Executive of patients group National Voices advises the new organisation: “Don’t be an empire builder. The more you have to do, the more likely it will either duplicate or get in the way of what others are doing. Once you have a clear brief, communicate it clearly. Remember, if you can’t explain your job very simply to your children or your mum, then you have to wonder why you are doing it.”