Another step forward in reorganising Wiltshire's NHS : a few steps further and the NHS will be coping with Brexit

Written by Tony Millett on .

Partners in the STPPartners in the STPIn November reported how 'Very quietly the NHS for our area is once again being reorganised'.  Now a new senior NHS appointment brings these changes into full view.


Three NHS Clinical Commissioning Groups (CCGs) - Wiltshire, Swindon and Bath & North East Somerset (BaNES) - have appointed Tracey Cox as their single Chief Executive.   She will also lead the Sustainability and Transformation Partnership (STP) which covers the area of the three CCGs and is known by its initials as the BSW STP.

The STP brings together NHS providers, GPs, Clinical Commissioning Groups, local authorities, hospital trusts and other community organisations with the aim of joining up and improving health and care services.

As Chief Exec of the three CCGs, Tracey Cox will have her own staff - 'a single management team'.  So, as well as the STP being a extra organisational layer with its own staff (and budget for its running costs), joining up part of the three CCGs' work in this way will add yet another layer of management between the Department of health and NHS England and our local health services.

Wiltshire CCG will continue as an organisation - it has to as it exists and is governed by act of Parliament.  But its staffing and role will inevitably be reduced.  How far this will diminish the localised decisions that were promised (and have been working well) when the CCG was established, remains to be seen. 

I am sorry for mentioning the word, but this somewhat bizarre and ad hoc state of affairs results in part from Brexit - as well as from the 2017 loss of the Conservatives' majority.  Complex legislation to re-reorganise the NHS became impossible.

The realisation in Whitehall that the Lansley reforms - which introduced the CCGs and commissioning decisions made by clinicians - were not fit for current purposes, simply hit the buffers of the almost exclusive concentration (fixation?) of government and of civil servants on Brexit.  In addition, it would be politically risky to rely on Northern Ireland MPs to change NHS structures in England.

So the STPs and the linked-CCGs have emerged as work arounds to the Lansley 2012 Health and Social Care Act. And the STP is busy - in the words of its tag-line - 'Working together to transform services'.

Tracey Cox Tracey Cox Tracey Cox was previously Accountable Officer for BaNES CCG and Interim Senior Responsible Officer for the STP. She is used to splitting her time as while guiding BaNES CCG, she also served as interim accountable officer for Wiltshire CCG from October 2016 to May 2017.

Tracey Cox will oversee closer working between the three local CCGs aiming to 'use their collective resources more efficiently and streamline their respective decision-making arrangements': "Where it makes sense, we will work collaboratively to deliver health & care improvements for a larger population across the region. We will also continue with our existing plans for local integration and transforming services that benefit our local communities and are responsive to people’s needs."

"The views and the needs of people living in the local area will play a central role in the way we shape services in the future and we will be starting a programme of public engagement about this over the next few months.”

Wiltshire Councillor Jerry Wickham, chairs the BSW STP:  “I’m delighted that Tracey has been appointed to oversee closer integration of health and care services across our region. It is only through working together as a truly integrated system that we will be able to help people to stay well, act early to prevent ill health and, where care is needed, make sure it is delivered in a joined up way."

"This move builds on existing good joint working across the three CCGs and local authorities and is in line with what is happening in other areas of England.”

If the job facing our area's STP, the combined CCGs and Wiltshire CCG were not difficult enough, they are faced by the impact of Brexit.  This week The Lancet - the prestigious, peer-reviewed general medical journal - published a report on the NHS and Brexit. 

Its accompanying editorial was blunt as regards Brexit: "There is no good news for the NHS—or for health. In all scenarios, depletion of the NHS workforce is inevitable, care for UK nationals living in the EU is uncertain, and access to medicines, vaccines, and devices hangs in the balance...."

"UK politics is peering over the precipice into an abyss of deep uncertainty. Brexit options are, no doubt, a Hobson’s choice, but for the NHS and health, almost Any-Deal must be better than a No-Deal."