Weekly updates and essential insight into the NHS in the South West, by Will Hazell

Greater Bristol CCG?

The South West already has its fair share of fragile health economies.

Northern, eastern and western Devon, which has been in the success regime for over a year, and Cornwall, where the clinical commissioning group is in legal directions and the urgent care system is strained, both spring to mind.

But in recent months another health economy has entered that category: Bristol, north Somerset and south Gloucestershire.

North Bristol Trust has had problems with its accident and emergency performance for years, and Weston Area Health Trust’s sustainability issues are well documented.

But things have got significantly worse recently. North Bristol Trust experienced a rapid deterioration in its finances and was placed in financial special measures in July. At the same time, North Somerset and South Gloucestershire CCGs were both placed in the equivalent regime for commissioners.

A letter to the CCGs from Andrew Ridley, NHS England’s director for the South, underlines the health economy’s unenviable new status.

Mr Ridley said the locality faced “many challenges”, including “PFI costs, poor [primary care trust] financial legacies, distance from target issues, rising staff costs and of course an aging population”.

But he added: “Whilst these factors are in no way underestimated, they are all things that many other CCGs have faced around the country and we have not seen such a marked reduction or entrenchment of under-delivery to the scale we have in [Bristol, north Somerset and south Gloucestershire]”.

So what’s the solution to the health economy’s woes?

NHS England thinks that a “single commissioning leadership structure” is part of the answer, and the CCGs are currently weighing up plans for a single accountable officer or a full merger.

If they were to plump for full merger it would create a South West super-CCG, with a population approaching 1 million and an allocation of well over £1bn, making it one of the largest groups in the country.

You might ask whether this will fix the health economy’s problems or whether it’s just another bout of deckchair arranging.

But the people I’ve spoken to locally are positive about the move. For example, they point out that harmonising discharge criteria across the CCGs will streamline the process of returning people to their homes after a hospital stay.

For the sake of patients in Bristol, north Somerset and south Gloucestershire, let’s hope that’s the case.

Meanwhile, if there is a full merger, what will the new group be called – Greater Bristol CCG? Your suggestions on a postcard please.

New broom sweeps clean

Deborah Lee has had a baptism of fire since taking over as chief executive of Gloucestershire Hospitals Foundation Trust in June.

Last month she had to reveal that the financial numbers the trust had been reporting were completely wrong – it is heading for a large deficit rather than a surplus. She also had to take out a £20m loan to strengthen the trust’s cash position.

It appears the trust’s true financial state had been massively flattered by dodgy planning assumptions.

Ms Lee promised an independent review to ensure “this cannot happen again”, and she’s already ringing the changes.

Following the departure of finance director Helen Simpson, two non-executives left the trust last week, and the board has pledged to “strengthen its financial governance arrangements” and “bring additional financial skills and experience in its membership”.

As the saying goes: a new broom sweeps clean.

Deep South

Deep South is HSJ’s email briefing on the NHS in the South West of England.

It takes an in-depth weekly look at a region which is one of the NHS’s most innovative, but also one of its most turbulent. The patch includes the cities of Bristol and Bath, through Wessex and Dorset, and all the way down the peninsular to Lizard Point.

Please get in touch with any suggestions about what you’d like to see covered and any story tips: will.hazell@emap.com