What goes around, comes around.
Regions… remember them? We had them, binned them, and now… ta-da!
…they’re back.
The Lansley reforms were supposed to ‘liberate’ the NHS. Strip away layers of regions and bureaucracy… give us a sleek, modern system.
Instead, they were a liability…
…they hollowed-out the middle of Whitehall. We had more arms-length bodies than an octopus and an organogram with the complexity of a Jackson Pollock masterpiece.
The attempt to push ministers away from the operational management of the NHS didn’t work.
Minister after minister set about duplicating the departments of NHSE, to try and keep a real-time handle on what was going on.
Now, Wes Streeting wants to run the NHS from his desk in Whitehall and good luck with that.
So, here we are, reinventing the wheel with the Model Region Blueprint. Only this time the spokes are called ‘regional management’ instead of ‘regions.’
I’ve always thought a return to head-office, regions and district health authorities was a good move.
It gives the secretary of state the chance to get a proper feel for what’s happening. Getting (in this case) seven, regional chairs around a table (or on a Teams call) is easy.
Regions are big enough to properly deal with population health and district health authorities (we call them ICB) are close enough to the action to smell the cordite.
A close read of the document (page 5) reveals the future;
‘[eventually regions will take on]… the whole span of responsibilities, such as public health and social care, alongside current NHS functions.’
Public health and social care are in the bailiwick of local authorities. Are they due for a move? Is public health ‘coming home’?
Overall, I think this is a good move. I really do. I welcome it. I’m for it and an enthusiast… and by now you’ll realise there is a ‘but’ coming!
Perhaps not so much a ‘but’… more an even-so, or a notwithstanding, or…
…the trouble is… NHS reform is too often like fashion; shoulder pads, flares, the Ford Cortina and in our case, regions.
Live long enough and you realise everything comes back around if you wait long enough. Particularly in the NHS.
That’s because it’s easier to reorganise the NHS than to get a GP appointment.
Ministerial whim is all that is required … no evidence or impact analysis needed.
Everyone is distracted, excited and thinks things are happening.
Each time we rip up the wiring diagram, we waste years fiddling with organisation charts, missions and purposes instead of fixing what is actually wrong.
Regions are things happening but are they the right thing at the right time?
There is only one thing that really needs to happen. Will regions make it happen? Will regions fix it? Will new regions reduce waiting lists… because that really needs to happen?
The date of the next general election must be no later than Thursday, August 15, 2029.
Stripping out weekends and bank holidays I make that just under 1,000 days.
In that context, looking at waiting lists; data is reported monthly and can vary due to weekends, bank holidays, and (recently) industrial action.
Also the figures for waiting list reductions include more than just treated patients. Some are removed for other reasons, such as moving abroad, going private, or bluntly, sadly, they die waiting.
Official figures track pathways and a single patient can have multiple pathways. Meaning the number of individual patients on the waiting list is lower than the number of pathways.
That said…
About 50,000 people are added to NHS waiting lists every day.
About 30,000 patients were removed from the waiting list per day… on average, in the period after May 2025.
You can do the maths. There’s a likely gap of 20,000 a day and there are a thousand days before the election.
Streeting’s got a problem and it is not bringing back regions.
He has to make some moves and fast.
Regions are fine but they’ll be a distraction at a time when half the staff don’t know if they’ll have a job by Christmas.
Maybe he should be…
- Increasing clinical capacity where it counts; particularly in high-demand specialties. Push on with extended hours and weekend clinics.
- Targeting funding for high-wait areas; allocate resources to the procedures and services where patients are waiting the longest.
- Review patient pathways; invest in technology for triage, referrals, and follow-ups.
- Reduce demand for secondary care; by investing in primary and community care. Fewer patients reaching hospital means shorter waiting lists.
You can reorganise all you like and good luck with regions but without hands-on-the-patient, waiting lists will grow and grow…
… and that’s Streeting’s one job.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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