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

In one of his own final rhetorical gifts as NHS England chief, Simon (now Lord) Stevens told MPs that Matt Hancock had included a few “bonus prizes” in his proposed Health and Social Care Bill, in addition to the legal changes the NHS had actually asked for.

With the bill now in its committee stage in the Commons, and under a new health and social care secretary, there are requests for several of the baubles hung on by Mr Hancock to be thrown out.

We report on Friday that Sajid Javid has indicated he may well be willing to scrap one of the least popular clauses, which would give ministers the power to “call in” and block local reconfiguration plans at any stage. He is still thinking about it, but lobbying groups are focusing their energies on getting this removed or mitigated by a requirement to publish the original clinical case for the changes from the NHS.

It could turn out to be the first about-turn of the bill, although the government amendment is not expected until it reaches the Lords.

Thus far Mr Javid is standing firm on the other unpopular bits, namely: more general powers for the secretary of state, powers to chop and change quangos’ powers without legislation, and a power for NHS England to cap foundation trusts’ capital spending (without protections which FTs thought had been agreed).

Those following the bill are expecting more turbulence once it hits the Lords, where expert peers get stuck in to the detail, and where there’s more scope for government to lose votes. At that point, ministers could well give ground on other points above, and/or others which arise.

If it doesn’t, the legislation will move more slowly and government could run out of time to get the changes implemented by April next year.

Slightly less great expectations

When Royal Cornwall Hospitals Trust was included as an “HIP 2 trust” in the government’s 2019 plan for new hospitals, local chiefs began planning several large projects to transform the county’s NHS infrastructure.

But, fast forward two years, and the vision has faded somewhat.

RCHT’s allocation under the government’s New Hospitals Programme has been downgraded to a women’s and children’s unit, which had already been announced as a “hospital upgrade” by Boris Johnson shortly after becoming prime minister.

It’s true that this project’s budget has doubled since being included in the high-profile government programme, but this has come at the cost of losing the larger chunk of cash which the trust hoped it could spend on more modernisation at Royal Cornwall Hospital, a new electronic patient record, and community hospital refurbishments.

Instead of getting up to £300m-£400m, the trust has to make do with £186m for the new unit.

It’s not clear what prompted the government’s change of heart for Cornwall, but the switch is another demonstration that promised projects do not always come to fruition.

Cornwall’s scheme has been placed in the “agile” category, which comprises nine other projects that may see construction start before 2025, in another deviation from the government’s initial plan.

Originally, it was envisaged that six major redevelopments would be funded by 2025, with the other selected schemes eligible to access allocations after that. But – as has often been the case with NHS capital funding – nothing ever seems certain until it is delivered.