Insider tales and must-read analysis on how integration is reshaping health and care systems, NHS providers, primary care, and commissioning. This week by deputy editor Dave West.

The Queen speaks

NHS England’s proposals for legislation – finalised last month – have got a nod of intent from government, having featured in its Queen’s Speech on Monday.

In theory, even more important for integration is social care reform. This too got a nod in the speech, but with no detailed proposals, which has worried many in the sector who want to see something definitive.

The person who worked as Matt Hancock’s policy adviser until the summer, Richard Sloggett, has pointed out in HSJ this week the substantial political obstacles which both sets of proposals face.

With the government highly likely to hold a general election quite soon, they are effectively early manifesto commitments rather than actual legislation proposals for this term.

Informal authority

The regional team for London within NHS England and Improvement has advertised to recruit independent chairs of all four of its sustainability and transformation partnerships, and its one integrated care system. This sweeping approach across London is telling and not replicated in other parts of England, although there will be plenty of other systems seeking independent chairs too. My colleague Ben Clover has written an excellent piece on the prospects and context for these roles.

CCG mergers on/off

I wrote not long ago about the prospect of moving towards about 60-70 clinical commissioning groups. Pragmatism may dictate we actually land with around 70 or 80 in the next two years. This week, we are seeing decisions trickle out from NHSE/I over a batch of merger proposals put before them. A good clutch will have been approved – I predict – but it seems some have been knocked back as it is deemed they are not ready to come together on the tight timetable for 1 April.

Despite NHSE’s encouragement for mergers, getting through the bureaucratic hurdles has looked rather tight – and officials will want to avoid distracting rows like that which has emerged in Staffordshire. Those knocked back by NHSE/I may feel rather that they have been marched up a hill then back down again.