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

It seems like just yesterday Boris Johnson was photographed in front of the now infamous bus emblazoned with the proposal that £350m being sent to the EU each week be used to fund the NHS instead.

Now he’s on his way to Number 10, Mr Johnson will find there is a long list of suggestions for ways he could make good on that promise. 

NHS Confederation has been quick off the mark, stating the new prime minister needs to turn his hand to the “social care crisis”, the “NHS pension debacle” and “the unfinished business of funding capital spending, training budgets [and] public health”.

And why not? It might be fair to say he owes Simon Stevens a favour. The world was reminded during the leadership campaign that the NHS chief executive helped the future PM get elected as president of the Oxford Union. Surely a deed deserving of some £350m a week?

Should Mr Johnson find the coffers don’t quite stretch to cover everything on the wishlist, he may find the prevention green paper contains a few ideas for raising funds, such as extending the sugar tax to milkshakes.

(He could be forgiven for missing it, however. It was snuck out without fanfare or press release just before 7:30pm on Monday night – allegedly as part of a bid by Matt Hancock to keep the new boss happy, and ensure he doesn’t have to deal with any suggestions that may displease BoJo in the immediate future). 

Merger map mania

It’s on… after many years of endless chatter about clinical commissioning group mergers, dozens are now either firmly proposing or in advanced discussion about coming together in April next year.

HSJ analysis has identified 86 groups which have confirmed or are consulting over consolidations for 2020 – 45 per cent of the current 191 groups. (We have mapped them)

If they all go ahead, the total would fall by a third to 126. That’s a lot more than the total reduction of 20 going all the way back to 2013 (9.5 per cent of the original).

That figure of 126 is smaller than the 150-odd local councils with social care responsibilities – showing NHS commissioning is now, in many areas, going big. London is the easiest example, with single CCGs proposed in four out of its five sustainability and transformation partnerships, each spanning up to eight boroughs.

Although it’s not quite that simple, as in some patches CCGs are merging to patterns which don’t match their STP or integrated care system, and, in a couple of cases, cut across their boundaries. A new non-standard patchwork will, of course, emerge.

Considering the scale of the change proposed, the degree of concern has been pretty minimal. There is the odd objection from GPs or councillors – the loss of resource from financially healthy areas to their neighbours will be a source of concern – but mainly people are going with the flow.

That is perhaps a sign of the slowly-slowly softly-softly approach that’s been taken to bringing about this change in recent years – giving CCGs “a good death”, as HSJ once wrote. Or it could be down to sheer frustration with trying to work through the current joint management but split governance arrangements in place across much of England. Or perhaps it’s just down to the extreme dire straits that many areas find themselves in, with no confidence or evidence that the CCG set-up can get them out of it.

Will all the current proposed mergers go through? NHS England has been trying to make it easier to merge, yet still seems to be firing off some tricky requirements for people to jump through.

Some plans are likely to fall by the wayside for 2020 and come back for 2021; while other groups may yet come out of the woodwork and achieve consolidation in nine months’ time.