Corporate report

Independent Reconfiguration Panel: Annual business review 2023-24

Published 8 April 2024

1. Foreword

I am pleased to present the Annual Business Review of the Independent Reconfiguration Panel (IRP) for 2023-24.

This past year I was proud to celebrate the IRP’s 20 year anniversary of operating as a trusted source of advice to the government on changes to NHS services. I am happy to say that we also welcomed four new members to the IRP - Ann Lloyd, Angela McNab, David Stout and Andrea Young - and I look forward to working together with them in the years to come.

In January 2024, new intervention powers came into force via the Health and Care Act which gave the Secretary of State for Health and Social Care the ability to call in and make decisions on proposals for NHS service change. I am delighted that the IRP has been retained as a source of independent expert advice to the government to support the new call in process. The whole panel continues to stand ready to assist ministers as and when required on any issues related to changes to NHS services.

I would like to thank our Secretariat once again for supporting an excellent learning and development programme on reconfiguration issues over the past 12 months with a series of local and national guest speakers invited to our meetings. Because of this, our members have expanded their knowledge of broader healthcare policy and strategy and its impact on NHS service design. Topics we have covered include health inequalities, NHS workforce planning, and the evolving role of integrated care systems.

Over the past year, the membership terms of Zoe Penn, Mark Taylor, Nicholas Relph, Irfan Chaudry and Michael Scott came to an end and I would like to put on record my sincere thanks for their support to the IRP. They have all been committed and conscientious in their approach to our work and I send them my best wishes for the future.

Looking forward to next year, I will ensure that we continue our excellent working relationship with ministers, departmental officials and our wider health and care stakeholders as we work to improve NHS services in England.

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 the government about NHS reconfigurations in England.

Previously under the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, the Secretary of State for Health and Social Care was able to intervene in NHS reconfigurations upon receiving a local authority referral relating to the adequacy of consultation or whether the proposal was in the interests of the health service. The Secretary of State was able to ask the IRP to provide independent expert advice and recommendations to consider before making any decisions about a reconfiguration.

Schedule 10A of the National Health Service Act 2006, introduced by the Health and Care Act 2022, came into force on 31 January 2024. This schedule introduced a new power for the Secretary of State to call in and make decisions on NHS reconfiguration proposals at any stage of the reconfiguration process. The IRP has been retained as part of the new call in process and stands ready to advise the government as and when required.

2.2 Our terms of reference

An updated terms of reference for the IRP was agreed by the Minister of State for Health and Secondary Care. This took effect from 31 January 2024 and sets out that the IRP will:

• advise ministers on the use of the call in power under schedule 10A of the National Health Service Act 2006
• provide formal advice to ministers about called in reconfiguration proposals
• provide formal advice to ministers on proposals referred prior to 31 January 2024 under the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny Regulations) 2013
• consider any other issues referred to the IRP by ministers as appropriate

When providing advice, the IRP will have regard to the duties for the Secretary of State for Health and Social Care, NHS England and integrated care boards, including but not limited to:

• the NHS Constitution
• the quality, safety and effectiveness of services
• the need to reduce health inequalities
• the integration of services with other health-related or social care services
• the extent to which NHS organisations have involved or consulted with the public and local authority health overview and scrutiny committees in the development of a reconfiguration proposal

The IRP’s role is advisory and decisions on NHS reconfigurations will remain a matter for ministers. The advice offered will be independent of government and will be published for transparency.

The IRP will ensure that any recommendation to ministers for use of the call in power is separate to any future advice on the substantive issues of a reconfiguration proposal.

The government expects that, wherever possible, disagreements are resolved locally without recourse to ministers. To assist this, the IRP will also offer informal advice on reconfiguration issues to NHS organisations, local authorities and other interested parties upon request.

3. Our people

3.1 Chair and 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 System Oversight and Integration in the Department of Health and Social Care.

The Chair is supported by a panel of up to 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.

A full list of our membership is available at Annex A.

3.2 Chair and 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, although this time may increase significantly during periods when the panel is developing casework advice to ministers.

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.

3.3 Secretariat

The Chair and members are supported in their work by a Chief Executive, who works two days a week for the IRP, and a Secretariat, consisting of one full time civil servant employed by the Department of Health and Social Care.

3.4 Public appointments

Ministers in the Department of Health and Social Care made the following decisions on IRP appointments in 2023-24:

• members Graham Jagger and Tansi Harper were reappointed to serve a second term of three years from 1 October 2023 to 30 September 2026
• the terms of members Luke March and Rohan Sivanandan were extended for 12 months from 1 June 2023 to 31 May 2024, followed by reappointment to serve second terms from 1 June 2024 to 30 September 2025
• the terms of members Suzy Walton, Simon Brake and Rajesh Khanna were extended for 12 months from 1 June 2023 to 31 May 2024, followed by reappointment to serve second terms from 1 June 2024 to 31 December 2026
• the terms of members Elaine Strachan-Hall and Michael Scott were extended from 1 October 2023 to 31 December 2023 and Elaine Strachan-Hall was reappointed to serve a second term from 1 January 2024 to 31 December 2027
• Ann Lloyd, Angela McNab, David Stout and Andrea Young were appointed as new members for four years from 18 March 2024 to 17 March 2028

The public appointments process was managed by the Department of Health and Social and Care in accordance with the Cabinet Office Governance Code for Public Appointments. The regulation of public appointments against the requirements of this code is carried out by the Commissioner for Public Appointments.

The appointments were made on merit and political activity played no part in the decision process. However, in accordance with the code, there is a requirement for appointees’ political activity (if any declared) to be made public. None of the appointees have declared any political activity.

4. Our work

4.1 Formal advice on reconfiguration proposals

The IRP received a request for advice from Lord Markham, Parliamentary Under Secretary of State, Department of Health and Social Care, on 23 October 2023. The request was regarding a referral to the Secretary of State by Telford & Wrekin Council about the Shrewsbury and Telford Hospitals Transformation Programme, which is led by The Shrewsbury and Telford Hospital NHS Trust.

Telford & Wrekin Council’s referral asked the Secretary of State to review the decisions made about the accident and emergency department and consultant-led women’s and children’s services at the Princess Royal Hospital in Telford.

The IRP had previously provided advice to the then Secretary of State, The Rt Hon Matt Hancock MP, on the reconfiguration proposal in 2019. Lord Markham asked the IRP to look into the concerns raised by Telford & Wrekin Council and reflect on whether circumstances had changed sufficiently to warrant a change to our previous advice.

A subgroup of IRP members was convened to consider the case and further evidence was requested from the main parties involved. This included The Shrewsbury and Telford Hospital NHS Trust, the NHS Shropshire, Telford and Wrekin Integrated Care Board, NHS England, Powys Teaching Health Board and Telford & Wrekin Council.

The leader of Shropshire Council, the co-chairs of the Joint Health Overview and Scrutiny Committee for Shropshire, Telford and Wrekin, the Royal College of Emergency Medicine, and local MPs were also invited to submit comments.

The IRP’s report for Lord Markham was submitted on 4 December 2023 and later published on GOV.UK. It contained 13 recommendations for improvement and concluded that overall and subject to those recommendations, the Hospitals Transformation Programme is the best way forward to improve acute hospital services for the Shropshire, Telford and Wrekin Integrated Care System.

The Minister of State for Health, Andrew Stephenson MP, wrote to the IRP Chair on 21 December 2023 to accept all of the IRP’s recommendations in full.

4.2 Informal advice and support

The IRP offers informal advice on reconfiguration issues to NHS organisations, local authorities and other interested parties upon request.

In 2023-24, informal advice on NHS reconfiguration issues was provided by the IRP to:

• NHS England (national)
• NHS England (London region)
• NHS Somerset Integrated Care Board
• Devon County Council’s Health and Adult Care Scrutiny Committee
• Inner West London Mental Health Services Reconfiguration Joint Health Overview and Scrutiny Committee

4.3 Policy engagement

The IRP Secretariat and Chief Executive 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 Department of Health and Social Care’s reconfiguration reform steering and working groups on legislative changes to reconfiguration policy in the Health and Care Act 2022.

5. Our governance

5.1 Panel meetings

The IRP held six formal business meetings in 2023-24 with minutes from each meeting published on GOV.UK.

During the year, members were kept updated on ministerial priorities and national healthcare policies to place the work of the IRP in a strategic context and enhance members’ understanding of the potential drivers for future NHS service change.

IRP business meetings held in 2023-24:

• 16 May 2023, with guest speaker Sally Gainsbury, Senior Policy Analyst for the Nuffield Trust
• 11 July 2023
• 12 September 2023, with guest speaker Barny Leavers, NHS England, Director of the NHS Long Term Workforce Plan
• 14 November 2023
• 30 January 2024, with guest speakers Justine Richards, Chief Strategy Officer, University Hospitals Coventry and Warwickshire NHS Trust, and Peter Fahy, Director of Adult Services and Housing, Coventry City Council
• 12 March 2024

5.2 Department of Health and Social Care sponsorship

The IRP is sponsored by the Department of Health and Social Care 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 the Department’s accounts and is managed by the sponsorship team as the budget holders.

Meetings held with the Department in 2023-24:

• 10 May 2023: IRP annual review meeting with Will Quince MP, then Minister of State for Health and Secondary Care
• 16 May 2023 and 30 January 2024: Jason Yiannikkou, Director of System Oversight and Integration, Department of Health and Social Care, attended the IRP’s business meetings to update members on the policy priorities for our sponsorship directorate and the commencement of the ministerial intervention powers for NHS reconfigurations implemented via the Health and Care Act 2022

5.3 Public relations and communications

Communications and media handling support to the IRP is provided by Grayling, a public relations agency, who maintain a dedicated IRP press office.

The contract was awarded in 2022 after a competitive procurement process led by the Department of Health and Social Care.

6. Our priorities for 2024-25

6.1 Our advice to ministers

• We stand ready to offer our expert independent advice on NHS reconfigurations to ministers in line with our terms of reference and to support the Department of Health and Social Care’s strategic aims to improve health outcomes and provide high-quality and sustainable care at the right time and in the right place.

6.2 Our engagement

• We will maintain effective working relationships with our stakeholders and provide the Department of Health and Social Care, the NHS, local authorities and others with informal advice as required to support the government’s wider health and care objectives, while preserving our independence and integrity.
• We will continue our work with the Department of Health and Social Care and NHS England to contribute to their strategic reforms around reconfiguration policy and support the implementation of new reconfiguration legislation in the Health and Care Act 2022 which came into force on 31 January 2024.

6.3 Our membership

• We will build and maintain a high-performing and effective panel by promoting a culture of learning and an inclusive environment which values diversity of skills and experience from a range of different backgrounds.

6.4 Our governance

• We will ensure the highest standards of good governance and financial management in compliance with the Cabinet Office’s code of conduct for board members of public bodies and HM Treasury’s guidance on managing public money.
• We will be open and transparent by continuing to publish information via the IRP’s website on GOV.UK, including our advice to ministers, minutes of meetings, our register of interests, and information on the role of the panel and our members.

7. Annex A: IRP membership as of 31 March 2024

Chair:

• Professor Sir Norman Williams

Clinical members:

• 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
• Ann Lloyd
• Angela McNab
• David Stout
• Andrea Young

Read more about our members’ profiles on GOV.UK