Thurrock Nub News editor Neil Speight tries to get to grips with an increasingly multi-layered, geographically unaccountable and - quite frankly - financially puzzling structure of local NHS health care. This is a news report that contains opinion and we invite our readers to contribute their own thoughts via our Facebook page.

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A NUMBER of new directors have been appointed to the quango that commissions health services in mid and South Essex - but its bosses have remained tight-lipped about the salaries offered to its new appointees and they say the new look organisation will be 'streamlined' with the responsibilities of 22 executive director posts (and four accountable officers) squeezed into just seven new roles.

However, it is added that no jobs have been lost and none of the previous appointees have been made redundant.

Despite what appears to be a financial conundrum, Thurrock Nub News has been assured "Clearly this represents a significant reduction and will help reduce costs overall".

Nub News began asking questions after the announcement was made of a new chief finance officer for the mid and South Essex Clinical Commissioning Group. That is an organisation which is planned to replace the existing five CCGs in the mid and south Essex region. The appointments have gone ahead despite the reorganisation still not being sanctioned by NHS England and being opposed by a number of local authorities, including Thurrock Council.

The new man to take charge of the cash in January is Mark Barker who has been appointed to the new role of Chief Finance Officer (CFO) for the five CCGs which are Basildon & Brentwood, Castle Point and Rochford, Mid Essex, Southend and Thurrock.

His appointment was announced on the back of another announcement detailing more appointments to senior positions.

The welter of new appointments, changes in roles and realignment of existing roles and personnel is difficult to follow and Thurrock Nubs News' request for a clear and unequivocal statement of who is doing what, why, where and when – and what everyone is getting paid has fallen on stony ground.

The statement detailing Mr Barker's appointment says: "Mark Barker has been appointed in the new role of Chief Finance Officer (CFO) for the five clinical commissioning groups (CCGs) across mid and south Essex following an extensive search and selection process. The role is part of a streamlined Executive Team providing managerial leadership for the five organisations.

"Mr Barker was previously CFO for South East Essex CCGs and will take up his new role in January 2021. His appointment is integral to the transition of the five CCGs towards becoming an Integrated Care System, as part of a wider NHS strategic plan. Mr Barker will work with other NHS finance directors to strengthen working across finance teams and to prepare a single financial strategy for Mid and South Essex Health and Care Partnership.

"Anthony McKeever, Executive Lead Mid and South Essex Health and Care Partnership and Joint Accountable Officer for its five CCGs said: "I am delighted to appoint Mark to this new position with his wealth of experience. This important appointment will help us to manage NHS finances effectively as an Integrated Care System and enable us to invest in the best possible services to support the health and wellbeing of our 1.2 million local residents."

"Mark Barker said: "I'm looking forward to joining the Joint Executive Team for mid and south Essex CCGs and driving forward improvements in the way we manage NHS finances to deliver high quality services and outcomes for local people"."

Picking the bones out that statement is tough enough and allied to another announcement the whole confusing picture of health care in the region is difficult to follow.

There are multi-layers of health administration now in place – which make a mockery of former Conservative minister Eric Pickles' pledge of a 'bonfire of the quangos' when the Conservatives took over from Labour in 20120.

On its website the mid and South Essex Health and Care Partnership – which has taken the lead role in driving the pending closure of Orsett Hospital – details its own restructuring and a raft of senior appointments. It says: "A number of senior appointments have been made to a streamlined Executive Team providing managerial leadership for the five NHS Clinical Commissioning Groups in mid and south Essex. The focus of the new team will be supporting the health and wellbeing of local people by working in partnership with other health and care organisations including councils and charities.

"The appointments include an Executive Director of Nursing and Quality and an NHS Alliance Director (ADs) for each of the four areas across mid and south Essex. All appointees were current members of staff at the CCGs. They include:

• Executive Director Nursing and Quality – Rachel Hearn
• Alliance Director, Basildon and Brentwood– William Guy
• Alliance Director, Mid Essex– Dan Doherty
• Alliance Director, South East Essex– Tricia D'Orsi
• Alliance Director, Thurrock– Mark Tebbs

"The Executive Director of Nursing and Quality will provide Boards with strategic clinical and professional leadership for nursing and quality. Her responsibilities include safeguarding, adult and children's continuing healthcare (CHC), infection prevention and control, and HR services to mid and south Essex CCG staff.

"The Alliance Directors will be responsible for delivering improved services tailored to the needs of residents in their respective areas and for ensuring in particular that Primary Care Networks are supported and successful.

Anthony McKeever is again to the fore in the rhetoric, saying: "During these challenging times it is vital, more than ever, that we all work together across mid and south Essex to reduce inequalities and support the health and wellbeing of 1.2 million local residents.

"I look forward to working with the Joint Executive Team to drive forward real change working with our partners to achieve the best health outcomes for local people."

All these changes are going ahead without the official approval of the NHS – as the partnership actually concedes, saying: "Following these managerial changes, Mid and South Essex CCGs will soon be recommencing the process for developing an application to become one organisation. This engagement programme was paused in April 2020 due to the COVID-19 response but will be restarted again shortly.

"It is currently planned that an application to become one organisation will be submitted to NHS England by Spring 2021 so that if approved, the merger will take place by Spring 2022. The feedback received from residents and stakeholders between February and April this year (through face to face events up until March 2020 and through surveys until April) is currently being reviewed and further stakeholder engagement will recommence in the coming weeks."

Thurrock Nub News editor Neil Speight says he and other observers of local health services are finding it increasingly difficult to follow the plethora of changes, new roles and he has expressed concern about how much money is been spent behind the scenes, while the front line is significantly under-resourced and underpaid.

He says: "I thought I had a reasonable grasp of local government and public service bureaucracy but what is happening in our region is becoming increasingly complex and cross-threaded to the extent I have lost the plot.

"I have asked for explanations but all I get is more bureaucratic gobbledegook and when I ask a simple question like 'How much is all this costing' I get no answers."

We did get one answer from Mr McKeever who said: "Previously there were 22 Executive Director posts (+ 4 Accountable Officers} serving the Mid and South Essex CCGs. There are now just seven such roles. Clearly this represents a significant reduction and will help reduce costs overall.

"There are though no plans for redundancies as part of the revised Executive structure. Individuals' salaries are commensurate with the duties of the roles and appointed to according to NHS published very senior manager (VSM) contracts. Salaries of very senior managers are published in CCG's Annual Remuneration Reports."

Mr Speight concluded: "Having walked alongside the nurses, cleaners and support staff in the front line of the pandemic earlier this year as they asked for a fair day's pay for more than a fair day's work in the teeth of Covid-19 – and as they go into the Christmas period with an increasing workload and worries about not just their future, but their future health - I am sure they will be very reassured to know that lots of highly-paid bureaucrats are looking forward to what seems a very prosperous new year."