NHS regions introduce their own performance regimes as financial pressures mount

NHS England regions are introducing their own performance management regimes as financial and operational pressures continue across the health service.

The North West has developed a regional “performance accountability framework”, while North East and Yorkshire has introduced its own risk-stratification approach to help determine how organisations are monitored. The regional systems do not replace NHS England’s national oversight arrangements, but add additional mechanisms for managing performance within individual areas.

In the North West, the new framework incorporates the principle of “earned autonomy”, linking the level of regional oversight to the performance of individual organisations. Better-performing organisations can therefore receive greater autonomy, while those experiencing more significant challenges may face increased scrutiny and support.

North East and Yorkshire is taking a different approach, using a risk-stratification tool to help regional leaders identify and categorise risks across providers. The move comes amid significant financial pressures in the region and provides another way for leaders to determine where greater oversight may be required.

The developments come as the NHS attempts to improve operational performance while maintaining tighter control over spending. NHS England already operates a national NHS Oversight Framework for integrated care boards, NHS trusts and foundation trusts, providing a consistent approach to assessing performance and identifying organisations requiring improvement.

The emergence of additional regional systems means healthcare organisations could increasingly find their performance managed through a combination of national standards and locally developed oversight arrangements.

The changes also come during a period of wider restructuring across the NHS, with organisations facing pressure to improve productivity, control costs and meet operational targets.

For NHS leaders, the development is significant because different approaches are now emerging between regions. While national performance standards remain in place, the North West and North East and Yorkshire are demonstrating how regional teams can develop their own methods for determining where intervention, scrutiny or greater autonomy may be appropriate.

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