The essential stories and debate in health policy

Nothing has happened yet and everyone’s annoyed

The last couple of weeks has featured a flurry of excitement over the prospect of clinical commissioning group mergers.

No CCGs have merged since they were unofficially banned in April 2014, and NHS England has not said it will now allow mergers (well, it has behind the scenes, but formally it hasn’t).

But the fact that nothing has actually happened should not, of course, get in the way of a frank exchange of views (aka: a row).

Last week ago HSJ editor Alastair McLellan published an editorial with the headline “Many CCGs are not fit for purpose and must be reorganised”.

A few days later at the NHS Confederation conference, NHS England non-executive director Lord Victor Adebowale said STPs were not a response to the fact that in most health economies, CCGs were not able to fix underlying problems. That seems odd, because if CCGs are on the verge of fixing those underlying problems, then why on earth did NHS England bother with all this flapping about with STPs? (Lord Victor has since admitted to not reading the leader he disputed).

It also seems odd because plenty of good CCGs want to merge – so presumably they agree that they can’t currently solve the underlying problems alone, for one reason or another.

Anyway, NHS Clinical Commissioners co-chair Graham Jackson, also chair of Aylesbury Vale CCG (which, incidentally, wants to merge with its neighbour), has written a direct response to Alastair’s piece. He argues that “CCGs are playing, and will continue to play, a vital role in delivering a healthier future for local populations and a better service for patients”. Dr Jackson also accuses HSJ of “very unhelpful rhetoric… claiming firstly that what is really needed in the NHS is another structural reorganisation and secondly that sustainability and transformation plans can effectively be seen as replacements for clinical commissioning groups”.

The editor points out beneath the article that he didn’t quite ask for a wholesale reorganisation and didn’t say CCGs would disappear.

Whatever next? Perhaps something will actually happen.

But could there be another structural change?

There are 44 sustainability and transformation plans, and, at last count, 83 local digital roadmap groups.

This situation, admitted Paul Rice, NHS England’s head of digital strategy, at a Westminster Health Forum event on Wednesday, is a “mismatch” that needs to be “worked” on.

The lack alignment between the all-important STPs and their digital counterparts – the LDRs – which involve drawing up blueprints for paperless at the point of care services by 2020 is a problem.

Getting buy-in for digital plans that may deliver considerable long term benefits, but not necessarily short term savings, is already a hard sell in the current financial climate, and the geographical incongruity only compounds it.

So, what to do? Mr Rice did not elaborate on what exactly needs to be done, but Beverley Bryant, now at NHS Digital but until last month NHS England’s director of digital technology, told HSJ in April that any restructuring to LDR footprints would be a “local decision”.

Whatever the outcome in the long term, it will make no impact on the first iteration of the LDRs, which are due to be submitted to NHS England at the end of this month. A very, very mixed bag is expected.