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

Hancock abolishes Mondays

Secretaries of state are ambitious people and keen to make their mark. Matt Hancock has done this by dropping one of Jeremy Hunt’s more famous initiatives. The Monday meetings with the heads of the big arms length bodies would often also see trust chief executives (literally) called on to explain their performance issues.

Mr Hunt told the King’s Fund he would be surprised if they were not retained after his departure, given the diffuse and confusing architecture of the NHS.

Nevertheless, that is what Hancock appears to have done, signalling also a willingness to cede day to day responsibility for some areas to junior ministers.

Hancock’s own stated priorities are workforce, technology and prevention, so the new dynamic with the ALBs will be interesting. Especially given that a new NHS England chair is expected to be announced this week.

False economies

In a highly unusual move, the UK’s independent fertility regulator, the Human Fertilisation and Embryology Authority, has said that increased health risks to mothers and babies are an “unwitting consequence” of cuts to IVF funding.

The regulator, along with three other national bodies – the British Fertility Society, the Multiple Births Foundation, and Fertility Network UK – investigated the safety and financial cost to the NHS of multiple births. These are at least five times more likely to occur through fertility treatment compared to natural conception.

What their report revealed was shocking – twins are seven times more likely to be stillborn than singletons, while mothers 2.5 times more likely to die if carrying more than one child.

The report’s authors are now calling on commissioners to understand the wider consequences IVF rationing has on the health of mothers and babies and the resultant costs to the NHS.

Fertility treatment has long been an area of funding disagreement and commissioner investment continues to decline. Seven clinical commissioning groups do not now fund IVF at all, while 61 per cent only fund one full or partial cycle. This compares to the recommendations by the National Institute of Health and Care Excellence that CCGs provide three, full IVF cycles.

NHS Clinical Commissioners said IVF restrictions are a result of CCGs having to make tough decisions to keep within its funding pot. However, this is one of the first reports of its kind that links funding cuts to poorer outcomes and costs returning to the health economy at a later date.

The more the long term financial and quality outcomes are linked to short term funding decisions, the more difficult it will become for CCGs to justify service restrictions.