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

The meeting-in-common for the boards of NHS Improvement and NHS England last Thursday might have been most notable for the news that the combined entities were looking to slash their operating costs buy a fifth. Some of the more outspoken foundation trust chief executives have called for the central bodies to be slimmed down as the provider trusts face increasing strain. The two organisations have a combined budget of roughly £680m.

Providers and their commissioners will have to wait and see whether the intention to shift more responsibility to the local level actually happens. In practice this is always going to mean “How much room will local systems have to fail before the centre jumps on them?” In practice, probably not much considering performance and finances continue to deteriorate.

The other key point from the meeting was the admission from the person running the programme to integrate the two bodies that it had been “very challenging” and that the two bodies were “very different”.

It’s worth remembering also that NHS Improvement itself is not a statutory body, being comprised of the NHS Trust Development Authority and Monitor. Not all staff at NHS Improvement feel that amalgamation has gone well and another is already upon them.

Midsomer merger

In May, the NHS’s productivity tsar Lord Carter told HSJ integrated acute and community trusts are more efficient than stand-alone organisations.

Health chiefs in Somerset will be among the first to test this theory as Taunton and Somerset Foundation Trust (acute) and Somerset Partnership FT (community and mental health) target a merger by September 2019.

The trusts say they will save £50m (cumulative) over five years, which will be a welcome boost to a financially struggling health economy.

Members of the HSJ commentariat suggested this didn’t sound like very much for two organisations with a combined turnover of £480m, but if Lord Carter is right then further savings opportunities may present themselves.

The trusts are not anticipating redundancies as a result of the merger, but cannot rule anything out at this stage.