Update on the Recovery Support Programme

Agenda item: 4.2 (public session)
Report by: Dame Emily Lawson, Chief Operating Officer and Jan Thomas, National Director of Intensive Support and Recovery Support Programme
Paper type: For information and discussion
5 December 2024

Organisation objective

  • NHS Mandate from government
  • governance

Working with people and communities

What approaches have been used to ensure people and communities have informed this programme of work?

  • consultation/engagement
  • qualitative data and insight, for example, national surveys; complaints
  • quantitative data and insight, for example national surveys
  • partnership working with voluntary, community and social enterprise organisation

Action required

The Board is asked to note and discuss the information provided in the report.

Background and context

1. The NHS Oversight Framework (NOF) outlines NHS England’s national approach to oversight of integrated care board (ICBs) and trusts, and how it monitors performance against key NHS commitments.

2. The Recovery Support Programme (RSP), working with regional and national NHS England teams, provides focused intensive support and oversight to ICBs and NHS trusts/foundation trusts (‘NHS providers’) that are in segment 4 (also known as NOF4) of the NHS Oversight Framework.

3. The RSP has been in place since July 2021 and replaced the previous special measures’ programmes. There are currently 20 NHS providers and 3 ICBs enrolled in the RSP and the list of organisations is published on the NHS England website.

4. Organisations in the RSP receive support (for example, financially and through the provision of additional resource) for a time-limited period with exit criteria agreed that will demonstrate sustainable improvement and recovery. The RSP approach can be applied to an individual NHS organisation, or across a whole system, comprising the ICB and constituent NHS providers.

5. This paper outlines the current RSP approach and describes the work underway to update NHS England’s approach to improve performance in the most challenged organisations.

The current RSP approach

6. Organisations enter the RSP when the NHS Oversight Framework (NOF) segment 3 criteria is met and at least one of the following NOF segment 4 criteria, which include:

  • longstanding and/or complex issues that prevent agreed levels of improvement
  • a catastrophic safety failure
  • a catastrophic failure in leadership or governance that risks damaging the reputation of the NHS
  • a significant underlying deficit and/or significant actual or forecast gap to the financial plan
  • Care Quality Commission (CQC) recommendation (applicable to NHS trusts)

7. The RSP approach comprises 5 key strands:

a) The diagnostic: each organisation in the RSP undergoes a diagnostic stocktake to identify the drivers of underperformance. The process informs the conditions for the organisation to exit the RSP, identifies areas for development for an improvement plan and provides insight on leadership capability.

b) Oversight and challenge: regional support groups (RSGs) are responsible for overseeing and reviewing the evidence against the delivery of improvement plans. In addition, NHS England at a national level provides oversight through:

i. the appointment of an NHS England-employed improvement director to provide critical challenge to the organisation, and to oversee the development and implementation of an integrated improvement plan

ii. regular board-to-board meetings with each NHS organisation in the RSP, chaired by an NHS England non-executive director

c) Financial support to drive the improvement plan: negotiated with the organisation/system and agreed between the national RSP team and regions, each improvement director has a discretionary allocation of funding to facilitate improvement within the organisation(s) they are supporting.

d) Targeted support for delivery: access to subject matter experts to stimulate and support improvement, and is aligned to the organisation’s integrated improvement plan.

e) Continued review of the integrated improvement plan: this includes review and monitoring meetings with NHS England national executives where further potential issues can be identified.

8. Support for RSP organisations can also be drawn from other NHS England teams and wider NHS partners. This includes dedicated improvement support from NHS IMPACT, Getting It Right First Time (GIRFT), and the Emergency Care Improvement Support team (ECIST). Organisations may also receive enhanced oversight and support through ‘tiering’ in elective, cancer and UEC, or programmes such as the Maternity Safety Support Programme (MSSP) and the Investigation and Intervention programme (I&I) on financial delivery. Tiering, MSSP, and I&I support are currently agreed through separate processes from the RSP support. Work is currently underway to streamline and develop a single integrated diagnostic and mobilisation programme.

9. The specific support packages for each organisation in the RSP are coordinated by the improvement directors who are embedded in the organisation concerned for the duration of the programme. Where organisations are receiving support from more than 1 source the improvement director plays a critical role in ensuring join up between different support teams.

10. NHS England also has regulatory powers to support its role in overseeing and regulating ICBs and providers, including the use of ‘undertakings’ to focus the attention of trust and ICB boards on particular areas of concern or poor performance. Undertakings for NHS trusts and foundation trusts are published in the catalogue of licensed providers.

11. There is evidence to demonstrate that organisations improve following support from the RSP. Since the launch of the programme in 2021, a total of 12 organisations have successfully exited the programme after meeting the agreed exit criteria in their improvement plans.

12. On exit from the RSP, the trust or ICB transitions to segment 3 of the NOF, supported by a transitional recovery support package.

13. Almost all organisations in the RSP have experienced changes to Board-level leadership throughout their time in the programme, with changes to chief executive officer, chief financial officer, and chair being the most common. Several organisations have seen a comprehensive refresh of their senior executive team.

Developing our approach and interdependencies

14. As NHS England refreshes its Operating Framework, there are opportunities to update the current approach to the RSP and support organisations to recover more quickly and sustainably. This will include a deeper approach to driving a consistent regulatory approach for underperforming organisations across the country, mandating clear recovery plans and maintaining board accountability for effective delivery.

15. As part of this approach, NHS England will update its approach to the initial RSP diagnostic and ensure there is a consistent, independent diagnostic process to assess and analyse accurately the root causes of issues within organisations in the RSP, that will provide targeted insights for improvement.

16. The diagnostic will not only highlight the issues but will also provide a clear summary of the underlying drivers of poor performance, which may include structural, leadership, operational, or cultural factors. By understanding the root causes of these problems, NHS England will offer more targeted and effective support to address the critical problems that need the most attention. Jan Thomas, CEO of Cambridgeshire and Peterborough ICB, is leading this work with the support of national, regional and local partners.

17. Once the diagnostic has identified the core issues, the next step is to develop a clear time-limited improvement plan. These plans will be routinely reviewed between NHS England and the system/provider and supported with the necessary regulation and incentives. NHS England will ensure there is a structured and consistently applied process of oversight and consequences for non-delivery of improvement plans.

18. It is clear that organisations in the RSP need experienced and capable leaders who have a track record of turnaround and improvement. NHS England is developing plans to systematically identify and develop talented leaders at scale to match them to roles in organisations where they can make the biggest impact. Appropriate incentives and flexibilities will be applied to develop talented leadership teams and ensure they have the time, support and space to drive sustainable recovery in challenged organisations.

19. NHS England is also developing a management and leadership framework. This will include a single code of practice, a set of professional behaviours and competencies, as well as an official national curriculum and induction to raise the standards of management and leadership in all organisations.

20. More broadly, NHS England has committed to the development of a revised Oversight and Assessment Framework. The updated framework aims to respond to the conclusions of independent reports, including the Darzi Review, and will support the NHS to meet the ambitions of the 10 Year Health Plan. The updated framework will be published following the agreement of the operational planning guidance for 2025/26. The diagnostic process referenced above is being designed in line with the new framework, and other parts of the RSP process will be revised as needed to support delivery of the new approach.

21. NHS England will codify its approach to improvement and performance management for all NHS organisations through a performance, improvement and regulatory framework. This framework will cover all aspects of assurance, improvement and performance management, and will include the approach to RSP. The framework will embed improvement into the annual planning cycle, creating a clear and comprehensive offer to support delivery of improved performance across the NHS.

22. NHS England will monitor the progress of all NHS organisations through consistent oversight and assurance mechanisms, robust performance management and escalation, and ensure that NHS England deploys the most effective improvement support to the right part of the system when it is needed.

Timeline of entry and exit points for RSP trusts and systems

Download the timeline

Publication reference: Public Board paper (BM/24/41(Pu)