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

Unsubtle hints

Consolidation of clinical commissioning groups has been a slow burn. We started with 211 and still have 195 more than five years later.

National leaders are hoping now is the time that changes. They are taking 20 per cent out of the groups’ admin allowance in little over a year. There are plenty of unsubtle hints that NHS England would like this to happen via merger and joint working.

It is notable – however – that at yet another policy juncture, there is still no requirement to merge, even to become an integrated care system. Many in the provider world would have liked it to be so and, were NHS England’s leadership different, this would probably have happened by now.

Questions sparked by this intervention include whether the management costs saved in CCGs will pop up elsewhere – like ICS or providers; and whether merger will have to be all the way up to Sustainability and Transformation Partnership level or something smaller. The latter would be more comfortable for CCGs and often happier for local government, but may not be the world the centre is looking for.

Long overdue

Since the Francis Inquiry was published more than five years ago, the NHS has seen a raft of patient safety reforms. Plenty of new laws and regulations, plus regular pronouncements from former health secretary Jeremy Hunt.

Many have complained there has been too much knee-jerk reaction to events and scandals so the news of a national patient safety strategy to take stock and bring all these strands together will be welcomed.

In his first indepth interview, national patient safety director Aidan Fowler has explained his emerging vision for safety in the NHS.

It is clear he believes there has been a lot of good work done but now it needs some structure. Essentially, he calls for a bit of grip to be applied, so that what has been proven to work in one region can be improved and extended nationally to ensure all areas benefit.

His vision is of a national infrastructure for safety policy extending down from a new national patient safety committee, to the national team and the seven NHS regions, and finally to local providers who will have patient safety directors employed. These directors will have received consistent training and be familiar with the way the NHS system works for safety, such as the NRLS alert system.

For too long safety, and the way it has been handled as a policy issue, has depended on where you are. Aidan Fowler’s ambition to deliver “uniformity” is long overdue and welcome.