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

It’s fair to say anaesthetists have had a rough year. This is a group of the NHS workforce who have had barely any time to recover from the peak of the pandemic and now find themselves deep in the recovery phase.

And to add insult to injury, last week many anaesthetists in training found out there was no higher training job for them, because of a perfect storm of less overseas travel for work, a new anaesthetics curriculum being implemented and the lack of central flexibility to boost training places to meet demand.

The Royal College of Anaesthetists has acknowledged the psychological impact this will have on trainees and fellow Dr Helgi Johannsson told HSJ that although there are opportunities for trainees to gain non-training jobs, the college was worried some might leave the specialty altogether.

The college is clear that there is already a shortage of consultants, so this scenario could have a serious impact on the NHS’ ability to recover electives and the future robustness of the anaesthetists workforce.

Would a more flexible funding mechanism for training provision help? Most probably, but with a set budget there is little HEE can do to help.

Exception or rule?

The geography of the NHS is not always neat. It does not track local authority boundaries and many people will cross them in search of healthcare, with their nearest or most convenient hospital often being in another administrative district.

The NHS is still working through what this means for integrated care systems, with NHS England preferring ICSs to be coterminous with local authority borders. An ICS can cover more than one upper tier local authority area, but it should contain all of the area of each one.

Enter Frimley ICS and some of the most complicated geographies in the country. Frimley has to deal with five upper tier local authorities – three unitary authorities and then county councils in Surrey and Hampshire, covering a small part of both.

Fiona Edwards, the chief executive of Surrey and Borders Partnership Foundation Trust, has just been seconded to lead both the ICS and Frimley CCG. She will have the unenviable task of negotiating with NHS England over the future of Frimley ICS and whether it will be allowed to be an exception or forced to cede some of its territory – or even risk abolition.

Given that it has been seen as one of the most advanced ICSs, will NHS England stand firm on its principles or will it allow Frimley to be the exception which proves the rule?