The must-read stories and debate in health policy and leadership.

Devo damage

Greater Manchester’s performance against the headline accident and emergency target has been a growing concern ever since the devolution project started.

When devo (including a unique £450m transformation fund) was agreed with NHS England and the government, there was a clear expectation that it would enable the region to make faster progress and perform better than the rest of the country.

But its performance against the four-hour A&E target has consistently tracked below the national average since 2015, and it’s starting to fall further behind.

The latest stats show GM had another bad winter, with the four-hour standard being met in only around 82 per cent of cases over November, December and January.

In North by North West, Lawrence Dunhill now reveals this has triggered formal intervention from NHS England and NHS Improvement, due to performance dipping below the 85 per cent threshold agreed with GM for three consecutive months.

Costs vary on IVF

Commissioning inefficiencies are said to be “blocking” patients’ access to IVF, as new data reveals some areas are spending at least twice as much as others on a single cycle of fertility treatment, HSJ’s Sharon Brennan has revealed.

Information obtained via freedom of information requests by Fertility Fairness, a campaign group led by various charities, suggests 13 clinical commissioning groups spent at least £4,000 per cycle of IVF with their main provider in 2017-18, while six spent £2,000 or less.

Free IVF treatment on the NHS has become increasingly rationed over time, and the figures suggest more CCGs could offer more cycles of IVF if they were able to negotiate better prices.

The campaigners received FOI responses from 115 out of 195 CCGs. While some CCGs commissioned up to five different IVF providers, HSJ analysed the money CCGs spent on their main IVF provider. If a CCG did not indicate how many cycles it commissioned from each provider, HSJ used the highest rate paid by the commissioner.