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

Take note, Treasury

Matt Hancock today articulated his ambitions for making prevention central to the NHS. He told a room full of public health officials from around the world the NHS is not just a service; it’s a shared stake in society.

With shades of JFK, he said people must stop asking what the NHS should do for them and look to what they can do to help the NHS. They must take personal responsibility for behavioural factors of poor health. In other words: stop smoking, drink less, get more exercise, and have a better diet.

Mr Hancock may have been better off pointing his rhetoric at his Treasury colleagues because he did not address the funding crisis that has swept through public health provision in England.

NHS England had its £20.5bn boost confirmed in last week’s Budget. But, once again, public health was left outside the fence. Along with training and capital budgets, it is now vulnerable to £1bn cuts needed to keep the Department of Health and Social Care’s books balanced, according to the Health Foundation.

Mr Hancock was adamant this morning that most of the NHS funding boost will go towards dealing with long term health concerns, but Public Health England has seen its budget fall each year since 2015. Local government public health budgets have fallen by 32.5 per cent since 2012, according to the Health Foundation.

We shall have to wait until the spring before we find out if more cuts are to come.

Commissioning’s long tail

NHS England has made no secret of its desire to see a future consolidation of clinical commissioning groups. A reduction of CCG numbers would lower overhead costs and allow commissioners to plan for healthcare across a wider population.

To help achieve this, the shift towards sharing accountable officers across CCGs has been happening at pace. HSJ analysis has found that just under a third of the English population is now overseen by just 13 CCG leaders. In contrast, 11 sustainability and transformation partnerships have CEOs that, on average, manage a population of less than 300,000.

The moves to single AOs and management teams running very large systems raises some questions about accountability and recruitment. The AO post with the biggest population - North West London - was advertised openly. But elsewhere, recruitment sometimes involves spreading the AO of constituent CCGs across multiple others; much other management reorganisation is going on in the lower rungs too.

For the smaller systems, NHS England will no doubt be reviewing the speed of leadership consolidation and exerting pressure on CCGs to conform to its vision. Although the CCGs with the smallest average populations (Shropshire, and Telford and Wrekin) said they have no plans to share a leader, it is unlikely the centre approves of this sentiment.

Julie Wood, chief executive of NHS clinical commissioners, also pointed out that a leader responsible for multiple CCGs can’t be everywhere. She predicted a significant change in the structure of leadership, with an AO having to delegate responsibilities to new roles that will spring up at a local level to help implement commissioning decisions.

Updated on 7 November, to make clear that the North West London AO job was advertised. Inadvertently the previous version suggested that it might not have been.