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

Helping hand

It is not an easy time for the alliance of eight clinical commissioning groups in north west London.

The group is in some choppy waters with its finances. It ended 2018-19 with an underlying deficit of more than £100m. If you include non-recurrent savings then the deficit comes down to “just” £57m.  

This month the alliance released a 2019-20 budget which projects ending the year with an £87m deficit, missing the £21.5m control total by almost £66m.

But, with a little outside help, this gap could close.

The hoped-for help may come in the form of some payback for hosting GP at Hand. The digital GP service operates out of Hammersmith and Fulham CCG but uses video consultation to attract thousands of patients from outside the area.

The CCG alliance’s finance director told the joint committee this month that “the value of the healthcare provided to these non-north west London patients is just short of £22m”.

The CCGs would like that back, either from the CCGs where the patients originate or from the centre.

But the debate over who should pay for the care is a fraught one. All sides seem to agree on the size of the bill, just not who should foot it. 

Astute number crunchers will have noticed that, even if the north west London CCGs got the cash back, they’re still on track to miss their control total by around £44m. Still, better than last year. 


When NHS England published the inaugural annual report by its learning disabilities mortality review programme last year, it suffered considerable backlash. Most of the critics objected to how the report had been published – quietly, on a Friday, with no press release – and accused both NHSE and the Department of Health and Social Care of trying to “cover up” the findings.

Those findings were not particularly encouraging. It revealed the programme had struggled to make a dent in the thousands of reviews it is required to get through – just one in 10 had been completed.

Despite progress, this year’s report – not yet officially published, but HSJ has seen a leaked copy – shows continued struggles with the LeDer programme with 38 per cent of deaths still to be allocated to a reviewer and three-quarters of all death reviews yet to be finished.

In January, HSJ revealed that several CCGs claimed to be struggling to keep up with the amount of reviews, the most common reason being a lack of reviewer capacity.

The way the programme is set up and funded means those carrying out the reviews do so on top of their day job. As a result, the pace at which reviews can be done depends largely on when they can be fitted into somebody’s already-packed schedule. 

NHSE has offered up some money to tackle the issue, but many say it is too little, too late in the day. 

Beyond the poor performance, this year’s LeDer review identified some shocking themes. One of which, as reported by The Sunday Times, involved 19 cases where “learning disabilities” had been recorded as a reason for a “do not resuscitate” order.

Quite rightly, three of the report’s 12 recommendations address measures to make sure this does not ever happen in the future.