What is going on in England’s biggest health economy, by Ben Clover

There are a lot of caps about in the NHS at the moment. Caps on agency staff and caps on the amount staff can be paid per shift above the standard rate.

Possibly the least contentious has been the cap on the use of consultancies. Monitor had this in place for a while before it became NHS Improvement policy. And it applies to CCGs too, with spend over £25,000 having to be approved by the regulator.

So London Eye is indebted to colleague Lawrence Dunhill who unearthed data showing which CCGs were allowed what in consultancy support in 2015-16.

The capital seems to have been luckier (or pushier) than the rest of England in getting this money.

London CCGs’ projects requiring consultancy support fit into two broad areas, with some miscellaneous.

Improving primary care south of the river

First, Southwark CCG got nearly £1.5m to support changes to primary care.

This is not primary care in just the inner London borough but across six south east London CCGs.

In general, primary care in Southwark and similarly deprived Lambeth is slightly better organised than it is across the further flung boroughs (although these benefit from more settled communities). The drive to improve primary care across the patch is a tacit admission by the management in London that significant improvements will have to be tangible before unpopular changes to hospitals can even be considered again.

Lewisham CCG and the local authority won a legal battle with Jeremy Hunt in 2013 that saw a centrepiece downgrade of Lewisham’s A&E thwarted.

A happy side-effect of that confusion was that the trust special administrator process used to dissolve South London Healthcare Trust effectively started an STP process in south east London, ahead of anywhere else in the country.

A&E and the rest

The bulk of the remaining work outlined in the consultancy data release is for improving A&E performance at providers.

Hillingdon, Wandsworth and Kingston CCGs were either looking at the performance of their local hospital’s A&E unit or how the whole emergency care pathway worked in their patch.

Hillingdon Hospitals Foundation Trust has had a particularly hard ride on A&E performance over the past year, with surges in demand exacerbating more general problems with agency staff. The trust can pay London weighting (so is in a better position than organisations just outside the M25 but is still comparatively far-flung in London terms).

The review by Wandsworth is specifically of St George’s Healthcare Foundation Trust. While that organisation’s problems are consequential, more significant is another piece of consultancy work on the list.

A consultancy picked up £3m for “strategic planning and implementation of the south west London and Surrey Downs Healthcare Partnership Programme”.

Why is this significant?

Surrey Downs abuts the south west London CCGs, and it means the consultants will have been looking at St George’s as well as Epsom and St Helier University Hospitals Trust.

Attempts to get people to consider downgrading one or both of Epsom or St Helier hospitals have run into the ground and this payment indicates we’ll be hearing more on this at some point soon.

We now get to the intriguing “misc” section.

Kingston MP Zac Goldsmith has said he would step down if Kingston Hospital was downgraded (something a review in 2007 mooted) and it seems safe from changes-that-would-require-statutory-consultation for a while.

But the commissioning end of the borough has always seen itself as a contender for some kind of wholly integrated, one borough system.

It is this context that makes the consultancy support for a contract for “the design and testing of a new model of care and operating model for health and care services in Kingston” interesting.

What has this work recommended for how commissioners work with the trust, the council and the social enterprise that has run community services since the transforming community services model in 2011?

In a post-STP world, one CCG might have commissioned some work on behalf of a whole fifth of London.

Camden CCG’s £75,000 tender to “explore provider delivery opportunities” would be intriguing even if it was just for one borough. That it could be for work across the whole of north central London makes it even more so.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

As always, if there’s context I’ve missed, things of greater note I should be writing about in relation to this area (or more generally) get in touch confidentially at ben.clover@emap.com.