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

How much light?

When is the right time to bring clinical commissioning groups out of financial legal directions? The obvious answer might be when they appear to have got a grip on their finances and there’s some light at the end of the tunnel.

In the case of two Sussex CCGs, even a pinprick of light seems to be enough. NHS England is taking Crawley CCG and Horsham and Mid Sussex CCG out of financial legal directions just as the pair reforecast their deficit for this financial year to a whopping £71m.

That is nearly £25m more than originally planned and reflects overperformance on the main acute contract and a failure across the system to realise all the efficiencies expected.

NHSE’s actions may seem strange but are based on a belief that, despite the deficit, the CCGs are on the right track and in safe hands.

Improvements in management led to the CCGs coming out of legal directions for governance in late 2018 and, in 2018-19, they were close to the planned deficit. Things have fallen apart a bit this year but NHSE is placing its trust in the current management to turn things around and to work with neighbouring Surrey Heartlands Integrated Care System to deliver system-wide savings.

The move also allows the 1 April merger of CCGs across Sussex — which will see Crawley, and Horsham and Mid Sussex merge with Coastal West Sussex — to go ahead with no CCGs in legal directions. Given how troubled the Sussex health economy was just two or three years ago, that is an achievement.

Striking a different chord

The departure of Jon Rouse has led to a change in tone from Greater Manchester’s devolution team.

Shortly before moving back into local government, Mr Rouse gave an outspoken lecture which accused NHS England and government officials of paying too much attention to accident and emergency performance, while failing to encourage local leaders to address the underlying causes of ill health. He argued constitutional waiting time standards are “not the most important goals”.

This came after four years in which Greater Manchester has consistently lagged behind the national average performance against the four-hour A&E target, as well as average performance in the north of England.

In an interview with HSJ, the devolution team’s executive lead for strategy and system development, Warren Heppolette, struck a very different chord.

“Elevation of our return to constitutional standards as a priority for Greater Manchester has to be deeply recognised,” he said.

“Our approach [must be] based upon both pursuing [population health projects] that feel like they’re working, and maintaining quite a challenging conversation with ourselves as a system around why we’ve not been able to return to constitutional standards or a level of performance that would be more typical nationally on things like A&E.”

The time for experimenting is over, now it’s time to deliver.