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

Sleepless in Sussex

The Sussex health economy is thought to be among a small number of areas causing lost sleep for central regulators.

With seven clinical commissioning groups – five of which are in legal directions – in charge of commissioning and two out of three acute providers running large deficits, there is justification for senior officials’ worries.

One response is to concentrate power in the hands of those leaders judged to be competent. Marianne Griffiths, and her Western Sussex Hospitals FT team, were brought in to run the troublesome Brighton and Sussex University Hospitals Trust.

More recently, Adam Doyle has gradually assumed control of the seven Sussex CCGs along with East Surrey, which forms part of the health economy and sustainability and transformation partnership area.

Being joint accountable officer of eight CCGs is no easy job but Mr Doyle seems to have impressed. Three of the CCGs – Crawley, Horsham and Mid Sussex, and East Surrey – have been partially lifted out of directions, with NHS England judging their governance to have improved in the period Mr Doyle has been in charge.   

Finance, however, remains an issue and the CCGs are not out of the woods yet. They are forecasting a £51.2m deficit for this financial year. That’s in line with their plan but there is nearly £8m of unmitigated risks plus commissioner sustainability funding – worth a whopping £56.9m over the year – dependent on each CCG meeting its individual target. 

Mr Doyle will be celebrating today but the financial challenge may still give him sleepless nights in the months ahead.

Square one

Try running too quickly and you’ll either fall over, or soon find you’re running on your own.

That seems to be what’s happened in Trafford, in Greater Manchester, where leaders of the CCG had envisioned all their GPs creating, and being employed by, a single primary care provider.

But it’s been clear for a while that things haven’t been going to plan. Now, an independent review has detailed the fallout.

Following a survey and interviews with GPs and other stakeholders, the review said there had been some “fierce” criticism of the previous leadership at the CCG, with confusion, anger, and a lack of trust around how the project had been developed.

In line with the recommendations, the CCG’s new leadership will go back to square one and start trying to build a “bottom up” consensus about the best way for primary care to scale up and collaborate.

As plenty of NHS managers have found before, clinicians hold the real power to determine how services are organised, and simply telling them what to do isn’t going to get you very far.