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

Fifteen to five

Fifteen clinical commissioning groups in the south west, north west and north east of England have gained approval to combine into five groups next year.

These are the first groups to get the green light to merge in April 2020 of at least 49 that submitted applications to NHS England/Improvement ahead of a September deadline.

Reducing the number of CCGs is part of the NHS long-term plan, which states every integrated care system should “typically” be covered by just one CCG.

The call for mergers is partly to drive efficiency. As the plan explains: “CCGs will become leaner, more strategic organisations.” And, across the country, the groups have been asked to cut their running costs by 20 per cent.

But not everybody was successful. Although NHSE/I declined to provide a full list of approved, rejected and delayed mergers, HSJ is aware of one proposed merger  — between Shropshire CCG and Telford and Wrekin CCG — that has been given the thumbs down. 

NHSE/I’s vow of silence over the process means the reason for the rejection is not completely clear. But the national commissioner might be feeling cautious after CCG merger proposals were recently shot down by GPs in Staffordshire and the North West.

Less parroting, please

That the NHS’ estimated bill to carry out crucial building repairs continues to rise is about as surprising as the Pope declaring he is Catholic.

But the new annual Estate Returns Information Collection data, published on Thursday by NHS Digital, again highlights the disparity between the growing cost of the repairs and the amount the NHS is spending on maintaining its estate.

In the last five years, the total backlog maintenance cost has risen from £4.3bn to £6.5bn — yet trusts’ investment in maintenance has only risen from £369.8m to £433m.

Trusts have a duty to spend as much as they can to keep their buildings up to scratch, but the figures show they simply don’t have access to the capital required to fully tackle the problem.

When asked by HSJ about the discrepancy, the Department of Health and Social Care trotted out its usual lines, citing the £3.9bn allocated in 2017 and 2018, the “extra” £1.8bn announced this summer, and the Health Infrastructure Plan published earlier this month.

But, as HSJ has previously reported, the NHS is nowhere near receiving all this money yet. Some schemes given the green light in 2017 remain in limbo. Of the £3.9bn promised by former chancellor Philip Hammond, £700m was earmarked for backlog maintenance, but questions about how, where, and if this money has been spent yet remain unanswered by the DHSC.

It is undoubtedly frustrating for the department’s officials to wait for a long-promised multiyear capital settlement before being able to work out exactly how much money it has to play with.

But a little more acceptance of the lack of capital to deal with problems like backlog maintenance, and less parroting of the same defence every time the issue arises, would show the DHSC is as concerned as trust leaders about the NHS estate.