Daily Insight: Agonising wait

“Our project is in jeopardy.”

“Progress on the project may be delayed.”

“We cannot finish our outline business case.”

These quotes are all from people working on long-needed major hospital redevelopments, which were promised by the government in the run-up to the 2019 general election.

The three projects – in Watford, Leeds and Epsom – are among eight major rebuilds of ageing hospitals which were initially prioritised for delivery after Boris Johnson’s landslide victory.

But, two and a half years on, the trusts have had their target date for completion moved from 2025 to 2026-28.

And, as HSJ revealed yesterday, each trust has only been given £1m to cover their planning costs – an amount which falls far below what is needed.

This has led to concerns that the lack of funding for the preparatory work means their projects will be delayed even further.

The government, which is instead prioritising eight ongoing projects, said its approach would offer better value for money and ensure all 48 schemes in the programme would be completed by 2030.

Much rests on the Treasury approving national funding this summer so that building on prioritised projects can start. 

The delegation threat

NHS England’s plan is to devolve responsibility for funding and commissioning specialised services down from the centre to integrated care systems.

Precisely what will be devolved and when are to be confirmed, though NHSE’s national director for specialised commissioning told us services will be delegated only when an ICS is ready to take it on. NHSE will continue to be “ultimately accountable, including setting national policies and standards”.

Specialised service providers, however, are worried. The Shelford Group of 10 of the largest teaching and research trusts wrote to NHSE in March to say they are concerned the plan could lead to fragmenting provision, creating postcode lotteries and diluting quality and expertise.

They say they’re open to some services delegated to the ICS level, like renal dialysis or HIV testing in emergency departments. But they do not see how these examples “justify the wholesale move of commissioning” of nearly all specialised services to the local level.

Some HSJ readers took to the comment section to point out that the Shelford providers would say that, wouldn’t they?

But the prospect of centres of excellence that have built up the necessary critical mass to provide high-quality, complex, low-volume procedures is an ugly one.

We await more details on NHSE plans for devolution. The centre must ensure they include robust measures to guard against this.