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

Merging at pace

Clinical commissioning groups’ mergers are now moving at pace. By April 2020, there will be just 135 CCGs, a drop of 56 since April 2019 and of 76 since they were first set up. For the first time, the number of CCGs will drop below the count of 152 primary care trusts before Mr Lansley came along in 2010.

HSJ’s map of the mergers reveals the huge variation in merger sizes, both in numbers and in geography. For example, Kent and Medway is merging eight CCGs into one, while the second largest mergers involve six CCGs. The smallest mergers involve just two CCGs. (And of course there remain a fair few small groups which are not merging at all, so far.)

It will be interesting to see how these new CCGs develop from April. The largest will need significant management support to serve their sizeable populations, and if they’re to keep various local constituencies happy.

More mergers will be expected in April 2021 — perhaps bringing the total into double figures. But despite NHS England repeating in the recent planning guidance that it would like to see one CCG per sustainability and transformation partnership/integrated care system, it is highly unlikely to get all that it wants.

NHS Clinical Commissioners’ outgoing chief Julie Wood recently agreed with HSJ’s earlier prediction that the final number of CCGs is likely to fall somewhere between 60 and 80 — substantially more than the current 42 STPs/ICSs.

‘Wilful blindness’

An inquiry into Ian Paterson has warned that hospitals displayed “wilful blindness” as the disgraced surgeon performed unnecessary surgery on more than 1,000 patients over more than a decade.

The Paterson Inquiry raised similar worrying themes from other healthcare scandals and inquiries — dysfunctional management, lack of challenge from senior clinicians and colleagues looking the other way, and patient safety deprioritised.

Now, the challenge for the government is to make lasting changes to prevent such harrowing malpractice from happening again.

The inquiry, led by Bishop of Norwich Graham James, made 15 recommendations for ministers to adopt for both the NHS and private sectors.

The first is a single database publicising consultants’ practising privileges and key performance data, such as how many times a consultant has performed a particular procedure and how recently.

Healthcare professionals should also be suspended if they are under investigation and there is a perceived risk to patient safety, the inquiry added.

Bishop Graham called for the government to address gaps in liability between the NHS and private sector as a priority, and to introduce a “national safety net” so patients are never again left without legal cover in the way some of Mr Paterson’s patients were.

Time will only tell how many of the recommendations will be adopted, and in what form.

Junior health minister Nadine Dorries said in a statement that the recommendations are “extremely sensible,” and present a “route map” for the government. She promised the Commons will get a full response “in a few months time”.