Corporate report

Independent Reconfiguration Panel Annual Business Review: 2021-22

Published 6 May 2022

Applies to England

1. Foreword

I am pleased to present the Annual Business Review of the Independent Reconfiguration Panel for 2021-22.

Over the past year, COVID-19 has had an enduring impact on health and care services, and I pay tribute to the NHS and social care staff who have worked tirelessly throughout as we start to recover from the pandemic.

We have continued to provide our expert advice to ministers on reconfiguration proposals as well as sharing our advice and support with stakeholders. The Secretary of State for Health and Social Care accepted our advice in full on two cases last year on the reconfiguration of community services in Devon and stroke services in Kent and Medway, and I am proud of all Panel members for their insight and contributions to our work.

In July 2021, the government published draft legislation for the Health and Care Bill, including a new clause on reconfigurations to give the Secretary of State greater powers to scrutinise and intervene in proposals for NHS service change. I am pleased that ministers have announced their intention to retain the support of the Independent Reconfiguration Panel and we continue to follow the progress of the Bill through Parliament with interest.

As an advisory body, we stand committed to providing independent expert advice to ministers and we look forward to engaging with the Department of Health and Social Care, NHS England and others to build on our lessons learned and develop policies which deliver high-quality, safe and sustainable healthcare services for people across England.

Finally, I would like to thank all our Panel members and our secretariat for their support and advice, in particular Diane Davies, Simon Morritt, Linn Phipps and Suzanne Shale who completed their terms in 2021. I would also like to put on record my gratitude to Martin Houghton, who retired last year after 18 years’ service as our Panel Secretary, for his enormous contribution to the work of the Panel since its inception in 2003.

Professor Sir Norman Williams, Chair of the Independent Reconfiguration Panel

2. About us

2.1 Our role and purpose

The Independent Reconfiguration Panel (IRP) is an advisory non-departmental public body established in 2003 to advise ministers on proposals for NHS service change in England that have been contested by local authorities and referred to the Secretary of State for Health and Social Care.

The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 require NHS organisations to consult local authorities on any proposals under consideration for substantial changes to local health services.

A local authority may refer a case to the Secretary of State for Health and Social Care if it is not satisfied that:

• consultation has been adequate in relation to content or time allowed
• the reasons given for not carrying out consultation are adequate
• the proposal would be in the interests of the health service in its area

The Secretary of State may then refer the case to the IRP to review the evidence and give advice to ministers in accordance with the IRP’s Terms of Reference which reflect the government’s ‘four tests’ for NHS service change which are:

• strong public and patient engagement
• consistency with current and prospective need for patient choice
• clear clinical evidence base
• support for proposals from clinical commissioners

When considering the evidence, the IRP is also mindful of a further test introduced in 2017 by NHS England which requires that for any proposal which includes plans to significantly reduce hospital bed numbers, commissioners need to provide evidence that they have met one of the following three conditions:

• demonstrate that sufficient alternative provision, such as increased GP or community services is being put in place alongside or ahead of bed closures and that the new workforce will be there to deliver it
• show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions
• where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting It Right First Time programme)

These five test are set out in NHS England’s guidance for commissioners on planning, assuring and delivering service change for patients.

In addition to our formal advice role, the IRP also offers ongoing informal support and guidance to the NHS, local authorities and other interested parties on achieving successful service change to ensure that decisions about reconfigurations are sustainable and result in improved services for patients.

2.2 Our members

The IRP is led by our Chair, Professor Sir Norman Williams, who is appointed by the Secretary of State for Health and Social Care and accountable to the Director of NHS Quality, Safety and Investigations in the Department of Health and Social Care.

The Chair is supported by a Panel of 15 members, including experienced clinicians, NHS managers and lay representatives, with wide-ranging skills, knowledge and expertise, including an understanding of the difficult trade-offs involved in complex service change and a commitment to integrity and the principles of public service.

The Chair and members are supported by a secretariat consisting of a Chief Executive who works two days a week for the IRP and one full time civil servant as IRP Secretary.

Members’ remuneration

The Chair receives an annual salary of £36,780, plus travel and expenses, for a time commitment of up to two days per week.

Members are entitled to claim a fee of up to £300 per day, plus travel and expenses, for a time commitment of one to two days per month.

Appointments and recruitment

Four members reached the end of their terms and left the Panel in 2021-22: Diane Davies, Simon Morritt, Linn Phipps and Suzanne Shale. Our previous IRP Secretary, Martin Houghton, also retired from his role in June 2021 after 18 years’ service to the Panel. We thank them all for their valuable contributions to our work.

Six new members were appointed to the Panel: Luke March, Rohan Sivanandan, Dr Suzy Walton and Professor Simon Brake from 1 June 2021 and Elaine Strachan-Hall from 21 March 2022. Panel recruitment was undertaken by the Department of Health and Social Care’s appointments team and all appointments were made by ministers on merit in accordance with the Cabinet Office Governance Code for Public Appointments.

Continuous professional development

To ensure the Panel is effective, we seek to constantly improve our performance and develop members’ skills to maximise their contribution to the work of the Panel, particularly with a number of new members joining and in light of the constraints around the pandemic.

For 2021-22, Panel members were supported with a comprehensive induction and development programme including:

• one to one meetings with the IRP Chief Executive
• buddying relationships with more experienced members
• shadowing the Devon case referred by the Secretary of State
• a case study event to review learning from previous casework
• an annual appraisal by the IRP Chair with a common set of objectives
• guest speakers sharing their knowledge and experience at IRP business meetings

IRP membership as of 31 March 2022

Chair:

• Professor Sir Norman Williams

Clinical members:

• Dr Irfan Chaudry
• Dr Rajesh Khanna
• Professor Anthony Schapira
• Elaine Strachan-Hall
• Dr Miles Wagstaff

Lay members:

• Tansi Harper
• Graham Jagger
• Luke March
• Rohan Sivanandan
• Dr Suzy Walton

Managerial members:

• Professor Simon Brake
• Dr Zoe Penn
• Mark Taylor
• Nick Relph
• Michael Scott

Read more about our members’ profiles on GOV.UK

3. Our work

3.1 Formal advice to the Secretary of State for Health and Social Care

Devon community services

The Secretary of State for Health and Social Care commissioned advice from the IRP on 8 November 2021 on NHS Devon Clinical Commissioning Group’s proposals entitled ‘Modernising Health and Care Services in the Teignmouth and Dawlish area’ which had been referred by Devon County Council’s Health and Adult Care Scrutiny Committee.

The referral was made on the grounds of inadequate consultation and the Secretary of State also asked the IRP to consider the impact of the proposals on people with protected characteristics under the Equality Act (2010) and also to consider system resilience and the impact of COVID-19.

The Panel considered the referral on its merits and submitted our advice on 23 December 2021. We concluded that NHS Devon Clinical Commissioning Group had consulted adequately with the Scrutiny Committee in terms of content and time allowed but suggested that both parties should conduct a joint review of the lessons learned to prevent similar issues happening again in future. The Panel also advised that the NHS must engage with the local community to determine the future of the Teignmouth Community Hospital site along with a series of further recommendations.

The Secretary of State accepted our advice in full on 17 March 2022 and a copy of our advice letter is available on GOV.UK.

Kent and Medway stroke services

On 27 March 2019, Medway Council’s Health and Adult Social Care Overview and Scrutiny Committee referred NHS Kent and Medway Clinical Commissioning Group’s proposals to reconfigure stroke services to the Secretary of State on the grounds that it was not in the interests of the health service in its area.

The Secretary of State asked the IRP for advice on 19 June 2019 which we submitted on 30 September 2019. The Panel concluded that the proposal should proceed alongside the commitments to deliver business cases for comprehensive stroke rehabilitation and prevention.

The Secretary of State accepted the IRP’s advice in full on 4 November 2021 and agreed that the proposal should proceed in the form of three hyper-acute stroke units and a local network of services. The IRP’s advice is published on GOV.UK.

3.2 Informal advice and support

In addition to the Panel’s formal role in advising ministers, the IRP also provides general support and advice to the NHS, local authorities and other interested parties on effective service change.

Throughout the year, various stakeholders approached the Panel for informal advice. The Panel has been mindful of the potential conflict of interest should a proposal for reconfiguration later be formally referred to the IRP, therefore the advice offered is always generic rather than specific in nature.

Informal advice given in 2021-22:

• local authority on Devon community services
• NHS member on health services in South Tyneside and Sunderland
• local campaigner and local authority on health services in Calderdale and Huddersfield
• NHS member on health services in London
• local campaigner on health services in Kent and Medway
• local authority on health services in North East London

Feedback continues to be positive with those involved in reconfiguring NHS services welcoming the opportunity to talk through issues and to hear about good practice from other parts of the country.

3.3 Policy engagement

The IRP secretariat had a number of meetings and conversations with stakeholders to discuss facilitating effective service change, revising guidance and disseminating learning and good practice throughout the year, including participation in the following working groups:

• NHS England and NHS Improvement’s co-production group for developing system-wide guidance on working in partnership with people and communities
• the Department of Health and Social Care’s reconfiguration reform steering group on legislative changes to reconfiguration policy in the Health and Care Bill

4. Our governance

4.1 Panel meetings

The IRP held five formal business meetings in 2021-22 with minutes from each meeting published on GOV.UK.

During the year, members were updated on issues affecting the Panel’s work including understanding the different approaches to reconfiguration, the impact of COVID-19 on services, and changes to the draft legislation on reconfigurations in the Health and Care Bill. Outgoing members also reflected on their experience and what they had learned during their time with the Panel.

IRP business meetings in 2021-22:

• 14 July 2021
• 8 September 2021, with guest speakers from the NHS Trust Policy and Legislation Programme teams in the Department of Health and Social Care
• 17 November 2021
• 19 January 2022, with guest speaker Dr Tim Ferris, National Director of Transformation, NHS England and NHS Improvement
• 16 March 2022, with guest speakers from the NHS Trust Policy and Legislation Programme teams in the Department of Health and Social Care

4.2 Department of Health and Social Care sponsorship

The IRP is sponsored by the Department of Health and Social Care (DHSC) and maintains an effective working relationship with officials in accordance with the principles set out in the Cabinet Office’s guidance on partnerships with arm’s-length bodies: code of good practice.

All income and expenditure relating to the IRP forms part of DHSC’s accounts and is managed by the sponsorship team as the budget holders.

Meetings held with DHSC:

• 11 June 2021: IRP Chair and secretariat meeting with Marian Holliday, Deputy Director of Acute Care
• 24 November 2021: IRP Chair and secretariat meeting with Tim Jones, Deputy Director of NHS Trust Policy
• 11 January 2022: IRP secretariat meeting with Tim Jones, Deputy Director of NHS Trust Policy

4.3 Public relations and communications

Communications support to the IRP is provided by Grayling, a public relations and public affairs agency, who maintain a dedicated IRP press office to provide media and relationship management services to the Panel.

The IRP’s contract with Grayling is due to end on 19 July 2022. An invitation to tender will be advertised to award a new contract for public relations support to an appropriate supplier through a competitive process.

5. Our priorities for 2022-23

Our advice to ministers

We stand ready to offer our expert independent advice on NHS reconfigurations to ministers within agreed timescales to enable service change and support the delivery of high-quality, safe and sustainable healthcare.

Our engagement

We will maintain effective working relationships and provide the NHS, local authorities and others with informal advice and share our learning from reviews to support the development of NHS service change while preserving our independence and integrity.

We will work with DHSC and NHS England to contribute to their strategic reforms around reconfigurations and integration in the health and care system and support the implementation of new legislation from the Health and Care Bill.

Our membership

We will maintain the high standards expected of those who serve on the boards of public bodies in accordance with the Cabinet Office’s Code of Conduct.

We will develop the skills of our members to maximise their contribution to the role and maintain a high-performing Panel in line with the IRP’s Code of Practice.

Our governance

We will endeavour to be open and transparent in our work by sharing information via the IRP’s website, including publishing our advice to ministers and information on the role of the IRP and its members.