NHS Improvement
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| NHS Improvement | |
|---|---|
| Name | NHS Improvement |
| Formation | 2016 |
| Dissolution | 2019 |
| Headquarters | Wellington House, Waterloo Road |
| Region served | England |
| Leader title | Chief Executive |
| Leader name | Jim Mackey |
| Parent organization | Department of Health and Social Care |
NHS Improvement was an executive non-departmental public body established in 2016 to oversee providers of acute, mental health, community and ambulance services in England. It was created by bringing together bodies including Monitor (NHS) and the NHS Trust Development Authority to provide single-system oversight, governance and performance management until its functions were merged into NHS England in 2019. The organisation worked with a range of institutions including Care Quality Commission, Public Health England, Health Education England and local NHS Foundation Trust boards.
History
NHS Improvement was formed in April 2016 through the consolidation of Monitor (NHS), the NHS Trust Development Authority, the Patient Safety Domain functions from NHS England and elements of NHS Litigation Authority to create a unified regulator for provider organisations. The move followed documents and initiatives by the Department of Health and Social Care and policy papers from ministers such as Jeremy Hunt seeking regulatory reform after high-profile investigations like the Francis Report into Mid Staffordshire NHS Foundation Trust. During its existence it absorbed programmes from NHS Employers and partnered with NHS Confederation on provider-facing guidance. In 2018 government decisions to streamline national bodies led to the transfer of NHS Improvement’s remit into NHS England by April 2019, aligning commissioning, planning and provider oversight following reviews including recommendations by the King's Fund and the House of Commons Health and Social Care Committee.
Organisation and governance
The executive structure included a Chief Executive—initially Jim Mackey—and a board comprising non-executive directors appointed by ministers in the Department of Health and Social Care. Governance arrangements referenced accountability to Parliament through the Secretary of State for Health and Social Care and reporting lines that involved scrutiny by the Public Accounts Committee and the Health Select Committee. NHS Improvement maintained regional offices coordinated with NHS England Regional Teams and liaised with organisations such as Integrated Care Systems and Sustainability and Transformation Partnerships. It employed policy, finance, quality and legal teams and worked with arm’s-length bodies like the Care Quality Commission on inspection and enforcement activity.
Responsibilities and functions
NHS Improvement’s remit encompassed financial oversight of NHS Foundation Trusts and NHS trusts, performance management of acute trusts, ambulance trusts and mental health providers, and delivery of national patient safety programmes that built on work by NHS England and Patient Safety Collaborative networks. It issued provider licence conditions, set sector-wide efficiency targets and operated turnaround and special measures regimes used previously in cases such as Mid Staffordshire NHS Foundation Trust and Morecambe Bay NHS Foundation Trust. It ran improvement initiatives including the safety improvement programmes influenced by Don Berwick’s recommendations and collaborated with NHS Resolution on litigation and risk management. NHS Improvement also produced guidance for workforce planning alongside Health Education England and supported capital prioritisation in collaboration with NHS Property Services.
Relationship with NHS England and other bodies
Although distinct, NHS Improvement maintained a close operational partnership with NHS England through memoranda of understanding, joint programmes and shared leadership on national initiatives like the Five Year Forward View. It worked alongside regulators such as the Care Quality Commission for quality assurance and with Public Health England on population-level safety issues. Collaborative governance arrangements involved interaction with commissioners including Clinical Commissioning Groups and regional organisations such as Sustainability and Transformation Partnerships and Integrated Care Systems. The organisation engaged with professional and representative bodies including the British Medical Association, Royal College of Nursing, Royal College of Physicians and Association of Directors of Adult Social Services to inform policy and operational guidance.
Performance, targets and regulation
NHS Improvement enforced provider licence conditions inherited from Monitor (NHS) and monitored compliance with financial control totals, NHS Constitution pledges and operational performance standards such as A&E waiting time and cancer waiting time targets. It set cost improvement programmes and assessed financial sustainability through control totals, use of Sustainability and Transformation Fund allocations and special measures interventions. Performance reporting was scrutinised by bodies including the Public Accounts Committee and academic analysts at institutions like the Nuffield Trust and Health Foundation. Outcomes included publication of quarterly performance dashboards and targeted interventions where providers breached licence conditions, with escalations sometimes involving chair and chief executive changes at implicated trusts.
Controversies and criticism
NHS Improvement faced criticism from observers including the British Medical Association, the Royal College of Nursing and investigative reports in outlets such as The Guardian and The Independent for perceived overemphasis on financial targets over quality of care, echoing concerns raised after the Francis Report. Critics argued that merging regulatory roles risked conflicts with functions held by NHS England and the Care Quality Commission, and unions warned about impacts on staffing linked to efficiency drives during disputes involving UNISON and Royal College of Nursing ballot actions. Parliamentary inquiries by the House of Commons Health and Social Care Committee questioned oversight of provider failures and the effectiveness of special measures. Academic commentators from King's College London and policy analysts at the Institute for Government debated whether centralisation improved accountability or diluted local clinical leadership.