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National concern?

Cambridgeshire and Peterborough Clinical Commissioning Group’s decision to push back the discussion of hugely controversial proposals to axe NHS-funded IVF just hours after HSJ reported the recommendations raises fundamental questions over who is really in charge of commissioning local services.

The CCG had been due to discuss the plans at its board meeting on Tuesday as part of a larger package of cuts and savings it said were needed to correct its perilous financial position.

It said it needed to save £32.7m to hit its target of achieving a £75m deficit in 2019-20 – a huge deterioration from the £35m deficit it recorded last year.

But, just hours after HSJ reported the controversial recommendation was set to be put before the board, the CCG issued us with a new statement.

It said: “The CCG has today [1 July] received new information from the Department of Health and Social Care about the commissioning of IVF services. Because of this the CCG has decided to review this information with NHS England and bring the decision back to the CCG governing body on 6 August.”

HSJ understands the information in question was, in fact, a letter health minister Jackie Doyle-Price had written to CCGs on 17 June to warn them it was “not acceptable” to cut IVF services.

Such cuts caused an “unfair” postcode lottery, “psychological distress for patients” and “untold reputational damage” to the NHS, the minister said.

Why the CCG opted to wait several weeks to react remains a mystery. But perhaps wider questions hang over the issue: Can national consensus be found on NHS IVF access while the budget is severely limited? What role do ministers have in clinical commissioning? Has national oversight trumped local decisions?

Finance teams hoping for some loosened purse strings for buildings and maintenance spending during 2019-20 may want to steer clear of their mail. NHS England and Improvement have sent a letter asking trusts to cut their combined capital spending plans by a fifth.

The regulators pleaded with trusts to scale back their grand plans in May, as capital spending plans exceeded the limit set by the Department of Health and Social Care by some margin. 

This appeal, however, only persuaded providers to slice 3 per cent off of their combined spending proposals. So, the national bodies have now told providers to work on a system basis (within their sustainability and transformation partnership or integrated care system) to prioritise spending.

Chief finance officer Julian Kelly’s letter also contained words of warning for anybody tempted not to have a go at rejigging their figures. Mr Kelly noted achieving the reductions quickly will mean that “emergency loan funding, where agreed as a local priority, can be released to providers without further delay”, while a consultation will be launched on “regulatory levers we may need to use, as a last resort and on a highly targeted basis, where affordable plans are not agreed by an STP/ICS”.