The must read stories and debate in health policy

Trusts take on council decision

For all the talk of integration and defragmentation in health and care, the laws of the service can still appear to encourage the opposite behaviour.

This has been highlighted in the North West where a public health contract for school nursing and health visiting services was set to be awarded by Lancashire County Council to Virgin Care.

The company reportedly won the contract by the “narrowest of margins” ahead of a joint bid by Lancashire Care Trust and Blackpool Teaching Hospitals Foundation Trust.

The trusts, which are the incumbent providers of the services on their patches, said their bid was in keeping with the ethos and aspiration of the area’s sustainability and transformation partnership.

While the services in question are quite small, the council’s decision has notable consequences.

A contract award to Virgin would mean the trusts collectively missing out on £20m a year, and (if you believe local campaigners) would lead to a further fragmentation of health services in the county.

However, Virgin has already picked up another contract in West Lancashire for urgent care and community services so it is not an entirely new player in the health economy.

There is more to come in this story, as the trusts have challenged the council’s procurement, which has forced it to delay awarding the contract to Virgin.

The incident adds fuel to the argument that proper integration in the NHS can only be achieved with new legislation that addresses the competition and procurement issues that come with the internal market.

Merger to upsize trust

The smallest acute trust in England is due to merge with its neighbour, after years of struggling with unsustainable services.

University Hospitals Bristol FT confirmed on Wednesday its intention to merge with its smaller neighbour, Weston Area Health Trust, which also supports the move.

The decision to merge had been widely anticipated, with Weston struggling to attract the staff to maintain a sustainable emergency service for years, but it has long been resisted.

The larger trust has been helping its neighbour since May 2017, especially after Weston General Hospital was forced to “temporarily” close its emergency department overnight in June.