Essential insight into England’s biggest health economy, by Ben Clover

Hackney and the City

Where is the London devolution agreement?

HSJ reported earlier this week that the devo deal had been delayed – and there are plenty of reasons why that could be.

Overly powerful councils could be part of the problem. Too many actors in London could be another. London is not Greater Manchester.

But as ever when some compromise does emerge, it will be interesting to see whose intransigence/legitimate-concerns-about-accountability held things up.

Devo Hackney doesn’t count. But well done to the plucky inner London borough, not everywhere is this advanced. The real test will come when the integrated commissioning boards try to do something controversial.

It is also one clear week since the budget and there’s been no date set for publishing the Naylor review on property. Why the delay?

South East London and Circle

Note to commissioners, if you’re planning a big change to MSK services, do an impact assessment. Especially if you’re going to maybe end up with high profile disruptive innovators Circle.

Don’t say you had done an impact assessment when you hadn’t done an impact assessment, then when challenged to produce your impact assessment, admit you hadn’t done an impact assessment, before doing an impact assessment.

Step forward Greenwich CCG on this one.

Anyway, the impact assessment has now been produced (I hope PwC didn’t charge too much for this work).

Surprise surprise, it says giving control of a load of the orthopaedic work to Circle will hit Lewisham and Greenwich Trust’s bottom line.

Circle had a difficult time in Bedford not so long ago with a very similar scheme. Bupa was run out of western Sussex when they tried something along these lines.

It’s problematic for commissioners that trauma and orthopaedics are the same specialty. The latter, a lucrative service under the tariff scheme, is subsidising the former, which is part of the politically untouchable A&E service.

What if a trust was doing more elective work than was necessary in order to maximise income? Shouldn’t cheaper MSK treatment be offered instead?

It’s hard to see how this wouldn’t play into the STP’s plans for elective care in south east London.

Although Circle’s MSK work is going to be largely outside of hospital, it will reduce the amount of work done inside it.

In that light, the STP’s plans to consider a three centre model for the patch’s inpatient orthopaedic care rather than the previously announced two site plan is significant.

The clinical work on this is being led by Cambridge’s Julian Owen and Health Education South London.

A commercial model similar to the South West London Elective Orthopaedic Centre is being considered for the patch and if public consultation is required it will begin in late spring, London Eye has been told.