Corporate report

IRP annual business review 2024-25

Published 4 April 2025

Foreword                                                   

I am pleased to present the annual business review of the Independent Reconfiguration Panel (IRP) for 2024-25.

This has been the first full year of the Secretary of State’s intervention powers over the reconfiguration of NHS services since the powers came into force in January 2024 via changes to the NHS Act 2006, as amended by the Health and Care Act 2022. As was highlighted in Parliament during the development of the legislation, the IRP has an important role to play in safeguarding the intervention process by providing impartial expert and clinical advice to help the Secretary of State to determine whether to use the call in power, as well as advice on any called in NHS reconfiguration proposals.

Over this period, we have continued to invest in our relationships with stakeholders across the system, including NHS England, NHS Confederation, royal colleges and the voluntary sector. In addition to our national role, we have also given informal advice to those working at a local level, such as NHS bodies, local authorities and the public, about any NHS reconfiguration issues they may encounter to help resolve disputes without recourse to ministers and support the autonomy of local NHS integrated care boards.

In regard to wider government priorities, I was delighted to provide evidence to Lord Darzi’s independent investigation of NHS performance, in which I highlighted the many operational pressures currently driving NHS reconfigurations. The IRP also submitted an organisational response to the 10 Year Health Plan engagement exercise to contribute suggestions for policy initiatives that the government and NHS England could take forward to transform NHS services effectively for the benefit of patients.

I would like to take this opportunity to thank all of the IRP members, including our new clinical member Mark Cheetham appointed this year, and our secretariat in the Department for Health and Social Care (DHSC), for supporting me to conduct the IRP’s role effectively. I look forward to welcoming new IRP members next year, subject to a decision from ministers, following DHSC’s public appointments campaign, which was launched earlier this year and remains ongoing.

Over the coming year, I look forward to developing a relationship with the Secretary of State and Minister of State for Health to support their aims for long-term NHS reform in the Health Mission and 10 Year Health Plan, particularly where these require front-line service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money.  

Professor Sir Norman Williams

Chair of the Independent Reconfiguration Panel

1.   About us

1.1   Our role and purpose

The Independent Reconfiguration Panel (IRP) is an advisory non-departmental public body established in 2003 as part of the government’s NHS Plan 2000. Our core function is to provide independent and impartial specialist advice to the Secretary of State for Health and Social Care about NHS reconfigurations in England.

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 Secretary of State retained the IRP under the new process to support effective and timely decision making.

The Department of Health and Social Care’s (DHSC) statutory guidance on Reconfiguring NHS services - ministerial intervention powers (2024) sets out that the IRP may operate as follows:

• advice of the panel can be sought informally by anyone to determine if a call-in request is appropriate or to seek support to resolve issues with a proposal locally
• the panel can provide independent advice to help the Secretary of State to determine whether to use their call-in power
• in cases where Secretary of State has chosen to use their call-in power, the panel will be available to formally support the Secretary of State’s decision-making by providing impartial expert advice

DHSC’s guidance on Local authority health scrutiny (2024) also sets out that where there are concerns about proposals for substantial developments or variation in health services, local authorities and the NHS commissioning body should work together to attempt to resolve these locally if at all possible. If external support is needed, informal advice is available from the IRP. This includes where agreement cannot be reached on a shared definition of ‘substantial’.

1.2   Our terms of reference

A new terms of reference for the IRP was agreed by the then Minister of State for Health and Secondary Care in early 2024 to reflect the commencement of the new intervention powers, along with transitional arrangements for any outstanding cases referred to the Secretary of State by local authorities under the previous 2013 regulations.

It 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

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

The IRP’s terms of reference is due to be reviewed in 2025 by ministers.

2.        Our people

2.1   Our Chair, Chief Executive 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 DHSC.

The Chief Executive is appointed as an office holder of DHSC for two days per week and is responsible for the day to day operations and management of the IRP, including its standards of behaviour and corporate governance.

The IRP consists of a panel of up to 15 members who are appointed by the Secretary of State to act in a personal capacity to provide independent specialist advice to ministers. The IRP members are drawn equally from three backgrounds - clinical, managerial and lay - to ensure a diverse range of skills, knowledge and experience.

Relevant areas of their expertise include acute clinical specialties, general practice, nursing, NHS leadership, healthcare academia and representing the public and patient perspectives. A full list of our membership is available in the Annex.

2.2   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 for ministers.

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

2.3   Public appointments

The Secretary of State appointed Mark Cheetham as a clinical member of the IRP from 1 November 2024 for a four year term. The public appointments process was managed by DHSC in accordance with the Cabinet Office Governance Code on Public Appointments.

A public appointments campaign for two lay members and two clinicians was launched by DHSC in early 2025 to replace the IRP’s outgoing members who are due to end their terms in September 2025. This remains in progress and a decision is anticipated from the Secretary of State in the coming months.

3. Our work

3.1 Independent advice for ministers

The IRP received no requests for advice from ministers in 2024-25. The IRP Chair wrote to the Secretary of State in October 2024 to explain the value of the IRP’s independent expert advice in helping them to be better equipped to undertake their statutory functions for the intervention powers over the reconfiguration of NHS services and to make timely evidence-based decisions.

As the Secretary of State is accountable to Parliament for the performance of the IRP, the appointment of our members and the policy framework within which we operate, the IRP Chair is keen to work closely together to build a trusted and constructive relationship. The IRP remains available to support the Secretary of State when local NHS proposals have been contested with them nationally to ensure the effective delivery of clinical services and to improve outcomes for patients.

3.2   Informal advice and support

The IRP offers informal advice on reconfiguration issues to NHS organisations, local authorities and other interested parties upon request to explain the call in request process and help resolve local disputes without recourse to ministers where possible. This service is managed by the IRP Chief Executive and secretariat in DHSC via our central mailbox at IRPinfo@dhsc.gov.uk.

Correspondence and enquiries

In 2024-25, informal advice on NHS reconfiguration matters was provided to:

• North Lincolnshire Council
• Hampshire Together New Hospital Programme
• NHS England, National Recovery Support Team
• Inner West London Mental Health Services Reconfiguration Joint Health Overview and Scrutiny Committee
• Protect Our NHS Bath & North East Somerset
• Suffolk County Council’s Health Overview and Scrutiny Committee
• Various members of the public

NHS Clinical Senates

In February and March 2025, the IRP Chief Executive, supported by IRP member Professor Simon Brake, attended two development days for the NHS Midlands Clinical Senates to discuss their experiences in reviewing NHS reconfiguration proposals and provide informal advice and support. Clinical senates are regional bodies, hosted by NHS England, that bring together a range of professionals to provide independent strategic advice to commissioners and others on how NHS services should be designed to provide the best care and outcomes for patients.

3.3   Policy engagement

Lord Darzi’s independent investigation of the NHS in England

The IRP Chair submitted evidence to Lord Darzi’s independent investigation in August 2024. This highlighted the IRP’s concerns that NHS service changes appear increasingly driven by operational necessity, for example because of long-term staffing shortages and the poor condition of some NHS estates. It also contained our observations of the many overnight or full closures of NHS services that still remain ongoing after originally being implemented as a short-term solution to manage pressures during the COVID-19 pandemic which is causing uncertainty for local communities.

The IRP Chair’s submission suggested that the centralisation of specialist services needs to be balanced with the provision of ‘core’ services for local populations to treat people closer to home. It also pointed out that there needs to be more consideration of both health and healthcare inequalities in service change planning, such as an assessment of inequalities in access to healthcare, the patient experience and health outcomes.

The submission also suggested that there is greater scope to streamline the decision-making for major capital schemes that involve the reconfiguring of NHS services to create a single end-to-end approvals process across NHS England and DHSC.

NHS Confederation Acute Network

The IRP Chair, Chief Executive and secretariat met with the NHS Confederation in November 2024 and attended their service reconfiguration roundtable meeting in December 2024 for a general discussion on the challenges and issues driving NHS reconfigurations across England with DHSC policy officials and various NHS leaders.

10 Year Health Plan

An organisational response to the government’s 10 Year Health Plan engagement exercise was submitted by the IRP in December 2024. Our contribution was focused through the lens of NHS service change and its supporting policy initiatives.

We set out the following ideas that we would like to see included in the plan:

• positive and clear positioning of the value and importance of NHS service change in improving the quality of care for patients and making the best use of resources
• a balanced approach to the centralisation of services supported by clinical networks and accessible ‘core’ local services
• public and patient involvement shaping changes to services with effective public consultation and local authority health scrutiny
• confirmation of the government’s approach to the system oversight and scrutiny of NHS reconfigurations while supporting devolved decision making at a local level
• a proportionate approach to the use of the ministerial call in power for intervention in NHS reconfigurations, supported by advice from the IRP and a refresh of the current statutory guidance and criteria for use of the power to confirm the policy intent

3.4   Relationship with NHS England

NHS England’s Chief Executive, Amanda Pritchard, and Chief Operating Officer, Dame Emily Lawson, met with the IRP Chair and Chief Executive in June 2024 to discuss the role of the IRP and NHS England’s assurance processes for reconfiguration proposals.

The IRP Chief Executive and secretariat attended NHS England’s meeting of the Oversight Group for Service Change and Reconfiguration in December 2024 to discuss approaches to scrutinising NHS services changes.

The IRP continues to have an effective relationship with NHS England officials at a working level, with the IRP Chief Executive and secretariat meeting with NHS England’s national System Assurance and Regulation team throughout the year.

4. Our governance

4.1 Panel meetings

The IRP held six formal business meetings in 2024-25 with minutes from each IRP meeting published on GOV.UK.

During the year, members were updated on ministerial priorities and health 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 2024-25:

• 14 May 2024, with guest speaker Dr Adrian Boyle, President of the Royal College of Emergency Medicine
• 9 July 2024, with guest speaker Sarah Hughes, CEO of Mind, mental health charity
• 10 September 2024
• 12 November 2024, with guest speakers Professor Kamila Hawthorne, Chair of the Royal College of General Practitioners, and Mary Elford and Matthew Winn, the Chair and CEO respectively of Cambridgeshire Community Services NHS Trust
• 14 January 2025
• 11 March 2025

4.2   Department of Health and Social Care sponsorship

The IRP is sponsored by DHSC which provides its secretariat and funding. The IRP does not produce its own accounts - any income or expenditure forms part of DHSC’s accounts as the sponsoring department.

Meetings held with DHSC in 2024-25:

• 20 May 2024: IRP annual review meeting with Andrew Stephenson, then Minister of State for Health and Secondary Care, and the IRP Chair and Chief Executive
• 12 November 2024: Jason Yiannikkou, Director of System Oversight and Integration, and IRP Senior Sponsor for DHSC, attended the IRP’s business meeting to update members on departmental policy priorities
• 11 December 2024 and 24 February 2025: IRP Senior Sponsor meetings held with the IRP Chair and Chief Executive

4.3   Public relations and media handling

Public relations and media handling support to the IRP is provided by Grayling Communications Ltd, a public relations agency, who maintain a dedicated IRP press office. The contract has been extended on an annual basis since it was first awarded in 2022 after a competitive procurement process led by DHSC.

5. Our priorities for 2025-26

Our independent advice for ministers

• we will continue to offer our impartial expert advice on NHS reconfigurations to support the Secretary of State to determine whether to use the call in power for contested NHS reconfiguration proposals, as well as give advice and gather representations from the parties for any proposals that have been called in for the Secretary of State’s own determination
• we will be available to act as a sounding board for ministers to draw on our expertise for the policy development of NHS reforms where appropriate, including those in the forthcoming 10 Year Health Plan, such as the shift of services from hospital to the community and the development of a neighbourhood health service
• this will support the Secretary of State to fulfil their legal duties in Schedule 10A of the NHS Act 2006 for intervention powers over the reconfiguration of NHS services and support the government’s Health Mission to build a health service fit for the future

Our stakeholder engagement

• we will be available to provide informal advice on NHS reconfiguration issues to NHS bodies, local authorities and the wider public upon request to help resolve any disputes at a local level without recourse to ministers to support the government’s aim to maintain devolved decision making by NHS integrated care boards where possible
• we will engage with stakeholders across the health and care system for their insights to inform development of our advice and identify potential challenges and opportunities around NHS reconfiguration planning, assurance and delivery

Our membership

• we will build and maintain a high-performing and effective panel with an inclusive and diverse culture which values different perspectives and backgrounds and upholds the values of the Seven Principles of Public Life
• we will work with ministers and the Department of Health and Social Care on succession planning and individual public appointments campaigns to support the Secretary of State to make timely, well-informed decisions about the appointment of new members

Annex: IRP membership as at 31 March 2025

Chair:

• Professor Sir Norman Williams

Clinicians:

• Mr Mark Cheetham
• Dr Rajesh Khanna
• Professor Anthony Schapira
• Dr Elaine Strachan-Hall
• Dr Miles Wagstaff

Lay members:

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

NHS leadership and management:

• Professor Simon Brake
• Ann Lloyd CBE
• Angela McNab
• David Stout
• Andrea Young

Read more about our members’ profiles on GOV.UK