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

There can be only one-ish

One thing which has arguably marked out the integrated care system policy in recent years has been its flexibility and ambiguity. There has been little to define ICS beyond something loosely along the lines of: “Organisations getting on well most of the time, generally being on the same page, and working together to try a lot of good stuff vaguely linked to integration.”

That has suited those involved – the project has stayed away from too much restructure-obsession, and avoided falling into the pitfalls of controversy or competition which have dogged attempts to create “integrated care providers” or “multispecialty community providers”.

But ICSs do have more bureaucratic reasons for their place on this Earth, and that is to make the current NHS structure simpler, with a much greater degree of clear regional strategic planning.

In many people’s minds, this requires stripping back some of the other layers of structure. Clinical commissioning groups – of which there are 191 at the moment – are normally the favourite target, with a lot of people imagining there will soon be one per ICS.

The NHS long-term plan went for a fudge by saying an ICS would “typically” be covered by only one CCG. And a lot of those involved with sustainability and transformation partnerships and ICSs would agree with that direction. It would certainly make their lives – and the lives of those managing them, like regulatory regional directors – more straightforward.

Yet the cookie cutter is never going to work for everyone. The objection especially comes from systems which are large and have more than one strong locality, with strong identities, personalities and often their own top-tier local authorities, underneath them. These include ICSs like the Greater Manchester devolution project and West Yorkshire and Harrogate, which are often held up as exemplars. There are others where this would spark quite a controversy, too.

In the end NHS England will not want to overrule GM, Yorkshire and others in this position; and Simon Stevens’ dictum so far has been “horses for courses”. So un-“typical” systems – and a commissioner landscape numbering well over 50 – might live on for some time.

Counting the discount

Would you shop at a supermarket which promised discounts for your bread, fruit and drinks, but, upon paying, doesn’t show you what discounts have been applied?

The answer is probably not. But trusts have found themselves unwitting customers at this oddly opaque store, unable to get a clear answer about the savings banked on their behalf by NHS Supply Chain.

Since April 2019, all trusts have effectively paid a percentage of their tariff-income to fund NHS Supply Chain, which has been tasked with buying common consumables and medical equipment while saving money for the NHS.

But, thanks to issues with its savings portal – called Libra – NHS Supply Chain is struggling to provide an accurate picture of what it is saving for each trust, causing problems for local cost improvement plans. Savings are currently being worked out manually, which takes longer and risks inaccuracies.

Earlier this summer, NHS Supply Chain told HSJ it hoped it would fix the problem by December. But, briefing papers seen by HSJ, reveal the timeframe has since been extended to the first quarter of 2020. If the problem does persist into 2020, the organisation faces a major battle to command the respect and faith of trusts.

NHS Supply Chain’s reorganisation was once described as among the highest-profile programmes within the government. In other words, the organisation cannot afford to fail.