NHS regions – what do they do and how are they changing?

NHS regional teams make up a significant part of the overall administration and management of the NHS but are largely invisible to the public. What is the role of NHS regions in the wider health system and how is their role changing with the publication of the Model Region Blueprint?

There has been a regional management tier of the NHS since its inception, although over the years there have been many changes to roles, structures and footprints. Regions have a bridging role between the centre (NHS England but soon to be the Department of Health and Social Care (DHSC)) and local commissioners and providers. This regional tier allows for closer management and greater understanding of local health needs and staff concerns than would be possible under national-level oversight alone, and with the changes proposed through the English Devolution and Community Empowerment Bill, the role of regions will only become more important. 

There are seven NHS regions, each with a corresponding regional team, currently sitting within NHS England. Around one fifth of staff working in NHS England are part of a regional team.

As things stand, regional teams are responsible for the quality of the health care services and the financial and operational performance of the NHS organisations in their region. This includes:

• reviewing the financial plans of integrated care boards (ICBs)

• scrutinising provider performance in areas such as A&E waiting times

• monitoring risks to safe and effective service delivery

• working with providers and commissioners, as well as other bodies such as clinical senates, to bring about changes to services to improve care for people

• holding responsibility for clinical workforce planning, training and education in their area

• specialised commissioning, such as for services relating to rare cancers or neuromuscular disorders, and in the prisons system.

The axing of NHS England and the overhaul of ICBs – both accompanied by significant reductions in staffing and operating costs – left the role of regions uncertain. The Model ICB Blueprint, a document outlining the refined future role of ICBs as strategic commissioners, indicated there would be some transfer of responsibilities from ICBs to regions. The subsequent launch of the Model Region Blueprint goes some way to painting the picture of regions’ future roles, but some areas still lack detail and there are questions remaining. So what does the future of NHS regions look like, as far as we know?

The Model Region Blueprint states that DHSC, as the headquarters of the NHS, will provide national strategic leadership, set priorities and budgets, and oversee national performance. Much of what regions do will remain the same: regions will ‘be the leadership interface between the centre and local health systems’, as the regulation and oversight of systems and providers is streamlined. They will continue to be responsible for performance-managing commissioners and secondary care providers, and for co-ordinating interventions and changes to services where improvement is needed.

However, the Model Region Blueprint raises a few questions, too.

The 10 Year Health Plan focuses on three shifts, including moving care from hospital to the community. The Model Region Blueprint states that each region will develop its own medium-term strategic plan in response to the plan. Regions will have responsibility for supporting partnerships between the NHS, local authorities, other government departments, and independent and VCSE organisations in their area. These partnerships and connections will, of course, be essential to enacting the three shifts outlined in the 10 Year Health Plan, particularly in establishing neighbourhood health, and it is positive to see these sectors all named in the blueprint. However, few other aspects of the blueprint point to the prioritisation of moving care into the community.

Moreover, regions’ oversight and management of provider performance does not extend beyond NHS trusts and ICBs. Primary care – which includes pharmacy, general practice, optometry and dentistry – is left out. The blueprint mentions the possibility of this responsibility being established in the future as neighbourhood health providers are developed, but it does not commit to this. For the time being, despite very significant squeezes on budgets and staff, ICBs will continue to be responsible for primary care performance and improvement. Will the blueprint perpetuate the primary/secondary care divide? Will regions be able to support the transformation to neighbourhood health when they have little sight of primary care?

Regions are set to become 'leaner' and more 'senior', with senior leadership teams to comprise people who have board-level experience in provider or commissioner organisations. Meanwhile, a 50% cut to the overall combined NHS England and DHSC workforce is expected, but regions’ responsibilities seem set to expand. How will this be managed with a smaller workforce? Few responsibilities will be stopped beyond specialised commissioning and, possibly, directly managed training programmes. The latter leaves the management of large clinical training programmes, including medicine, dentistry, pharmacy and health care science, uncertain at a time when ensuring the right education and training of the health care workforce is particularly important in the face of the three shifts. The blueprint also states that while leading emergency preparedness, resilience and response will initially be the responsibility of regions (newly handed over from ICBs), this will be reviewed. The Covid-19 pandemic showed just how vital emergency preparedness and response work is, and leaving this portfolio without clear ownership may risk its deprioritisation during a time of significant change to NHS structures.  

The government’s plans to rapidly roll out and expand strategic authorities and elected mayors across England has great potential to improve health and health inequalities, including through their relationship with integrated care systems – see our latest essay where we set out how this should develop – and with the wider architecture of the NHS including the role of regions. The Model Region Blueprint does reflect this change, and the strategic importance of this, but more clearly needs to be done to understand how strategic authorities, integrated care systems and NHS regions will relate to each other in the future.

Overall, the Model Region Blueprint sets out some clear indications of the responsibilities regional teams will have around strategic leadership, performance management and service improvement as the new NHS/DHSC operating model takes shape. However, it is striking that relatively little has changed from regions’ previous role, given the emphasis on the shift to community care in the 10 Year Health Plan. And there are some important questions that will need answering. NHS England has confirmed there will be future iterations of the Model Region Blueprint, so it will be interesting to see if, and how, they are answered.