The essential health stories and talking points from Tuesday

South West CCGs seek tie-up

When NHS England pressed the “reset” button in July, it announced that North Somerset and South Gloucestershire CCGs would be placed in “financial special measures” and told to work with Bristol CCG to move towards a “single commissioning leadership structure”.

As NHS management jargon goes, “single commissioning leadership structure” is typically opaque. But a few months on, details have emerged about what it’s likely to mean.

Letters between the CCGs and NHS England obtained by HSJ reveal it will definitely involve the appointment of a single accountable officer.

However, the CCGs confirmed to HSJ that they might go even further and undertake a full merger of the three organisations.

If the groups plump for that option it will lead to the creation of one of the country’s biggest CCGs, covering a population approaching one million.

However, just how much control the CCGs will have in determining their future appears open to question.

A pointedly worded letter from Andrew Ridley, NHS England’s director for the South, suggests the national commissioner is keeping up the pressure on the underperforming groups.

Mr Ridley sympathised with the “many challenges” the CCGs are grappling with, including “PFI costs, poor PCT financial legacies, distance from target issues, rising staff costs and of course an aging population”.

However, he goes on to say: “Whilst these factors are in no way underestimated, they are all things that many other CCGs have faced around the country and we have not seen such a marked reduction or entrenchment of under-delivery to the scale we have in [Bristol, North Somerset and South Gloucestershire].”

Ouch.

The CCGs have their work cut out over the rest of the financial year to nail down and implement their new structure.

The next staging post will be the appointment of a turnaround director to help make it happen.

UnitingCare chaos laid bare

A critical report of the commissioners and advisers involved in the collapse of the £750m UnitingCare contract is the last national level post mortem on the debacle before new guidelines are set out next month.

The PwC report, commissioned by NHS England, raised concerns about every step of the process, from the budget set by Cambridgeshire and Peterborough Clinical Commissioning Group to how the CCG and its advisers managed it.

The older people’s services contract collapsed just eight months into a five year deal in December 2015.

So did the latest review tell us anything new? There was no smoking gun, but the conflicting accounts from the different parties laid bare the disjointed nature of the process and went some way to explaining why such basic errors were made.

The report paints a picture of a fragmented approach that resulted in everybody thinking someone else was addressing key issues – like parental guarantees – so they slipped through the sizeable cracks.

NHS England and NHS Improvement are due to set out guidelines next month, which are supposed to be put in safeguards to prevent a repeat of such a pratfall procurement, and have vowed to more actively scrutinise future big ticket contracts.

But guidelines and increased central scrutiny will not be enough. The NHS has been rightly and regularly criticised for its disjointed approach to everything from procuring big contracts to service provision for years.

Until there is a cultural shift away from the fiefdom building nature of the system and its silos, the health service is vulnerable to a similar debacle.

The CCG and its advisers have been rightly criticised for making a series fundamental errors, but there will be others in the system thinking “there but for the grace for the God go I”.

This was a debacle born of a fragmented system as well as individual errors.