Intended for healthcare professionals

Observations Health Policy

Musical chairs in the NHS leadership waltz

BMJ 2019; 364 doi: (Published 13 March 2019) Cite this as: BMJ 2019;364:l1093
  1. Andy Cowper, editor, Health Policy Insight
  1. London, UK
  1. andycowper{at}

Do the latest changes signify the end of internal competition in the NHS?

Plans for NHS England and NHS Improvement to work more closely together are worth taking some time to understand.

The NHS Commissioning Board, which likes to call itself NHS England, represents NHS commissioning, planning, and provision. Monitor and the Trust Development Authority, which call themselves NHS Improvement, represent the NHS provider sector.

The intention to draw NHS England and NHS Improvement into far closer cooperation was first formally announced in March 2018.1 Last week a joint meeting of the two national arm’s length bodies announced their requests for parliament to make a range of changes to remove a range of competition aspects from the parliamentary legislation affecting the NHS.2

Change of strategic direction

This move follows the decision of NHS England’s chief executive, Simon Stevens, to change the strategic direction of NHS policy. Stevens used his 2014 Five Year Forward View to move NHS …

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