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

HSJ readers will already be well aware that Boris Johnson’s ‘40 new hospitals’ are not all they’re cracked up to be – more ‘40 new bits of hospitals’.

This was emphasised in Nottingham University Hospital Trust’s decision to dial down its plans for a refurb – the estimated cost for a brand new site consolidating two existing hospitals coming in at £4bn.

The trust decided this rather large price tag would not go down well with the DHSC and has instead plumped for a more modest £1.2bn. This will be spent on part refurb, part new buildings. Although this is still vastly more than the cost of other schemes, down the road at University Hospitals Leicester the estates work is more likely to cost around £590m.

NUH will be well aware of the risks here – that the £1.2bn might still be too much and further compromises might have to be made.

Put to the test

There has been plenty of debate within local systems about how they will respond to the government’s white paper on integrated care systems.

While the paper is prescriptive about the overall ICS structures, it leaves room for variation in the governance arrangements beneath that.

The key question, especially for larger ICSs in the north of the country, is the extent to which accountability and leadership will be delegated within each system to ‘places’, which typically means smaller areas coterminous with a local authority.

However, there will be limits to what local leaders can come up with, as NHS England is to devise a “test” which they must satisfy.

Speaking at an event on Monday, Bill McCarthy, regional director for the North West, said: “In the way we develop and support systems, we’ll be putting in a test…. why are you wanting to organise in this way? We will be looking to see that that’s legitimised, if you like.

“[It might be] because that’s how we’ll best relate to partners, that’s how we’ll work with communities, that’s the set of arrangements that will have the best impact on health outcomes, tackling inequalities and enhancing productivity, and really contributing to social economic development.”