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Lincolnshire has long faced challenges about the sustainability of its health services.

But last week there was good news: Lincolnshire integrated care system has been moved out of the highest tier of NHS oversight for the first time since it was placed there in 2021.

The county’s acute trust, United Lincolnshire Hospitals, was put into special measures for both finance and quality worries back in 2017, only coming out last year.

This meant Lincolnshire ICS was in segment 4 of the National Oversight Framework, to give its proper name, while none of the county’s trusts were.

CEO John Turner told HSJ the ICS had effectively taken on the task of fixing the finances, leaving hospitals to focus on care quality, leading to the delay.

ICS finance boss Matt Gaunt said many of the acute trust’s financial woes were down to the wider system and it was “unfair and a distortion of the reality” to ask ULHT to shoulder the burden itself.

Andrew Morgan, ULHT’s outgoing boss, was bullish about the future: “I’m absolutely confident that this isn’t a ‘here today, gone tomorrow’ improvement. We’ve embedded change processes, governance, people, systems. This is how we now do our business.”

Silas on silos

A full post-mortem of Greater Manchester’s financial downfall is still to be carried out but an early diagnosis was offered by one of its chief executives.

Silas Nicholls, the departing leader of Wrightington, Wigan and Leigh Foundation Trust, said the system has missed important opportunities to rationalise and create joint services during the last eight years.

He said GM is under significant pressure to explain why its staffing levels have increased by 18 per cent since 2020, compared to 14 per cent nationally, which has contributed to a mid-year deficit approaching £200m.

In an interview with HSJ, Mr Nicholls said the system could have made some “different choices” with a £450m transformation fund it was given as part of its five-year health “devolution” deal from 2016 to 2021. He cited pathology, virtual wards, and discharge processes as key areas where there should have been more collaboration.

GM is still cited in some quarters as being a “mature” ICS, but Mr Nicholls suggested it has struggled to move on from the previous era of competition.

He added: “I think we still live perhaps with a bit of the hangover from the foundation trust movement… with that sort of entrepreneurial spirit, tensions and rivalries between different organisations and what I’d call a sort of clinical arms race.”

Also on today

The full implications of the Lucy Letby case will take years to emerge, but one of the early effects will be around the configuration of neonatal services, writes Lawrence Dunhill in North by North West. And mythbuster Steve Black says the real issue with the Federated Data Platform is not its price tag or data security but the magical expectation the NHS has for the programme.