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

Feeling miffed

At what point does a state-subsidised company gain an unfair advantage over private sector competitors?

That is the question which has prompted discussions between the Department of Health and Social Care and Bunzl Healthcare over the former’s establishment of the new NHS Supply Chain, as revealed by HSJ.

Several sources told HSJ Bunzl (and possibly other large private sector suppliers to the NHS) is miffed because it is competing against a mainly taxpayer-funded company.

DHSC officials would have undoubtedly discussed state aid rules when the model was created, which suggests, although we cannot be sure, they believe there is no case to answer. Otherwise, the NHS Supply Chain structure would surely have been designed differently.

The company could ultimately consider a legal challenge, if it feels procurement law has been broken, although this would likely be a last resort.

Mega mergers

Merging clinical commissioning groups is no easy task, as the south east is discovering. There is rarely a neat solution which matches local authority areas and natural healthcare flows, as well as providing a sustainable framework for effective commissioning.

These issues are being played out in Sussex where seven CCGs are likely to be reorganised into three, dovetailing with the local authority boundaries in the area.

It’s an obvious way forward but will create a giant West Sussex CCG where patients look in several different directions for healthcare, including across the county boundary to Redhill’s East Surrey Hospital. And Brighton and Hove CCG will remain as a smallish entity, matching its unitary council.

East Surrey CCG, meanwhile, is likely to join the Surrey Heartlands CCGs in an integrated care system, marking the end of a long-running debate as to whether it belongs in the Sussex Sustainability and Transformation Partnership or the Surrey Heartlands one.

The CCGs may have little choice but to look at mergers – in particular, driven by the need to cut 20 per cent from their operating costs. But the fact it is even being discussed is a sign of how far the Sussex STP has come.

Something similar is happening in Kent and Medway where the eight CCGs are also mulling over a merger, which would form a single CCG covering a population of 1.8 million and two local authority areas, Kent County Council and Medway Council. Moving towards system-wide commissioning in Kent has taken a while to get traction but a single CCG would be a major step forward. 

Both counties’ mergers have barriers still to overcome – GP acceptance and NHS England approval for a start. But the developments show both STPs are maturing and starting to make progress in sorting out commissioning arrangements.