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

There was never any real doubt the “merger by acquisition” between Western Sussex Hospitals Foundation Trust and Brighton and Sussex University Hospitals Trust would go ahead. So it was no surprise the boards of the two trusts — and the council of governors at Western Sussex — gave it the thumbs up on Thursday.

Approval from NHS England and Improvement and the nod from the secretary of state are likely to come next week, with the formal merger going ahead on 1 April, creating a megatrust on the south coast.

Will this matter, given the two trusts have shared a chief executive and many other senior staff for the last four years? Yes, potentially. The trust will dominate the Sussex integrated care system, providing two-thirds of its acute services and inevitably having a powerful voice in ICS discussions.

It will also be able to embed its position as the tertiary trust for the area, with the full business case for the merger talking of “repatriation” of some work. The completion of the 3Ts project — redeveloping much of the Royal Sussex County Hospital site — will be crucial for this but it is running behind plan and is rumoured to be massively over budget.

The merger may also open up the possibility of more hot/cold splits and different uses of the five main sites — although the new trust is committed to keeping accident and emergency and maternity services in their current locations. There is potential for reconfigurations of other services, especially those which are small and fragile.

And, inevitably, there will be some savings to be made from only running one organisation. All of this will take time, so the merger on 1 April will be the start of a journey, not the end of one.

London lagging

London has been lagging behind in the covid-19 vaccine rollout since the programme began last December, with a lower proportion of people having the jab in the capital than other areas of the country.

This trend continues into uptake among staff in older adult care homes, according to the latest figures published by NHS England this week.

London local authorities make up 11 of the 12 areas where fewer than 60 per cent of older adult care home staff have received their first dose of the vaccine as of 14 March.

And London boroughs also make up eight of the lowest 10 councils for uptake among staff of independent care homes for younger adults, according to the figures.

A likely reason for low uptake in social care settings — which has also been cited for low uptake in London across the board — is there is higher representation of some ethnic, racial or social groups where there is more vaccine hesitancy.

Uptake among the country’s general population remains strong as the programme moves onto people aged 50 and over.

This week’s announcement that there would be significant vaccine supply issues throughout April prompted concerns the government would not continue to hit vaccination targets.

However, health and social care secretary Matt Hancock has insisted the programme is on track to offer the vaccine to all adults by July.