The NHS Reconfiguration Formula
No one noticed: the NHS ended up where it started.
When Wes Streeting, the Health and Social Care Secretary, spoke at the NHS ConfedExpo 2025 in Manchester about “our” vision for a new model of NHS care, we couldn't help noticing Wes’s fervent support for NHS reconfiguration.
“So if you need to reconfigure services to cut waiting times, modernise and improve productivity, you will have my support. In fact I’ve had nine reconfigurations cross my desk since becoming Health Secretary,” said Wes.
The TTE office employees are sufficiently long in the tooth to have witnessed several NHS reconfigurations.
In 2002, Strategic Health Authorities (SHAs) were established following the implementation of the Health and Social Care Act 2001.
SHAs in England initially served populations of about 1.5 million. They were responsible for leading the strategic development of the local health service and managing Primary Care Trusts (PCTs). The average size of the 152 PCTs in England was around 330,000 people.
The SHAs were reconfigured from 28 to 10 in 2006. These 10 were abolished in 2013 and replaced by NHS England and Clinical Commissioning Groups (CCGs). The average size of a CCG in England was approximately 226,000 people.
In 2022, CCGs were reconfigured into Integrated Care Boards (ICBs) as part of the Health and Care Act 2022.
The average population size managed by an ICB in England is around 1.5 million people. Some ICBs cover populations as small as 500,000, and others exceed 3 million.
To clarify, one SHA is equivalent to five PCTs in terms of population, and five PCTs are equivalent to one ICB. By performing some basic calculations and cancelling out the common factor, we can conclude that 1 SHA is equal to 1 ICB.
However, because in the interim, 1 CCG equated to 1.5 PCTs, no one noticed that the reconfiguration of services from SHA to PCT, then to CCG, and finally to ICB ultimately resulted in a return to the original position, with the addition of numerous managers and substantial extra costs. All clear?
Meanwhile the cash, our cash, will flow into the next reorganisation
This post was written by two old geezers who have been around long enough to recall these changes.
Talk about rearranging the deck chairs on the Titanic.
"To clarify, one SHA is equivalent to five PCTs in terms of population, and five PCTs are equivalent to one ICB. By performing some basic calculations and cancelling out the common factor, we can conclude that 1 SHA is equal to 1 ICB.
However, because in the interim, 1 CCG equated to 1.5 PCTs, no one noticed that the reconfiguration of services from SHA to PCT, then to CCG, and finally to ICB ultimately resulted in a return to the original position, with the addition of numerous managers and substantial extra costs. All clear?"
No. Not clear at all. Reminds me of the Register's units of measurement (handy converter here! https://www.theregister.com/Design/page/reg-standards-converter.html). Except that those are _funny_. Funnily enough, "NHS Budget" is one of their units of measurement of money!
It's making my head spin. Which is, no doubt, precisely the intention.
We need an evidence base for the strong hypothesis that, actually, there _is_ one group of NHS users who are utterly satisfied - nay, delighted - with the NHS? _Management consultants_.