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

COP26 has been and gone and NHS organisations remain busy writing their net zero plans which must be submitted by mid-January.

These plans will then be used to create a new set of strategies at integrated care system level, before both sets are reviewed by NHS England after April 2022.

But NHSE’s chief sustainability officer Nick Watts is only too aware of the risks around creating strategies at the cost of actually implementing meaningful change.

Speaking at an HSJ event this week, Dr Watts pledged to avoid “death by strategy” and he said the aim of setting “tight” timelines for the plans was to prompt local leaders to find the “low-hanging fruit” and thereby start reducing carbon imminently.

Dr Watts also said funding grants will be given to trusts and regions with the best ideas to help them scale up implementation, and he said ICSs should get ready for some “friendly competition” to stimulate innovation.

He also predicted some discomfort among trusts over the way in which NHSE will eventually calculate carbon reductions across the NHS, but said a unified approach was the only way forward to ensure consistency.

In some ways, Dr Watts has the hardest job in the NHS as his aim – to get a net-zero NHS by 2045 – will require the involvement of most, if not all, of the 1.4 million staff in the health service.

Therefore, pledging early on not to get tied down with strategies and plans seems a good start to getting people onboard. 

The long goodbye

Integrated care system and commissioning leaders believe there is a high chance that the move from clinical commissioning groups to ICSs will be delayed.

NHS England scenario planning seen by HSJ sets out four scenarios and says that a decision to delay by either three or six months would be made by 15 January.

It is not clear whether any of the options are currently preferred by NHSE, but officials are still asking local managers to continue to prepare for a 1 April changeover.

The potential spanner in the works is the Health and Care Bill, which has only just entered the Lords phase of its passage in Parliament. It has proved contentious, meaning that if the Lords amend it, it will have to be considered again in the Commons.

Several ICS leaders told HSJ they were concerned about the tight timetable for implementation. One said going live in October would be more sensible, allowing time for preparation and shadow running.

However, another said there was a risk that going live part way through the financial year would also fail, and that a delay of a year could mean the ICSs policy loses momentum, as well as being difficult for CCG staff.