HSJ’s roundup of Thursday’s top stories and discussion

Theories of devolution

Chancellor George Osborne’s announcement of a health and care devolution deal for Greater Manchester took the NHS by storm in February, including many in the NHS in Manchester. Since then the glow of excitement around devolution of health powers has dimmed a little, notwithstanding a promise of devo Cornwall in the July budget. This hasn’t been the case in local government, where councillors have been chattering intensively ahead of Friday’s deadline for requesting devolved powers from government.

On Thursday we revealed that Liverpool’s City Region has asked to “explore” some interesting new health and care powers, including:

  • the creation of a regional performance oversight layer;
  • getting its hands on NHS England’s specialised commissioning funds; and
  • greater local control of the ambulance service - ominously enough for ambulance providers.

Our brothers and sisters at Local Government Chronicle have reported that there’s also health devo interest in London, Gloucestershire and, tentatively, Derbyshire.

So far the mood is that in other key devo patches – such as Leeds, Newcastle, and Sheffield – the NHS and care sectors are being largely kept out of plans, with no ambitious grabs for power or integration. Perhaps the attitude is to let Manchester have a go first, which wouldn’t be unwise.

Winter warning

The worst accident and emergency performance against the four hour target in more than 10 years was due to hospitals struggling with very high bed occupancy rates. That is Monitor’s conclusion after a period of research.

The regulator has analysed responses from the majority of trusts and visited a number of hospitals across the country to try and understand why A&E performance slumped so dramatically last winter. Only 88.8 per cent of patients were seen and treated within four hours between October and December 2014.

On average, hospitals had bed occupancy rates of 89.7 per cent. Anything above 85 per cent is considered a risk to patients.

Despite frequent calls for more nurses over recent years, Monitor found that A&Es had enough staff, and there were 4 per cent more staff per attendance in comparison to 2013.

However, there was increased reliance on temporary staff which might spell trouble for the coming winter. In December, the agency staffing cap kicks in.

Tough decisions for CCGs

Nearly a third of clinical commissioning groups have implemented or are considering restrictions to services this year, HSJ research has found.

We sent freedom of information requests to all 209 CCGs asking whether they had introduced or planned limits to access or eligibility for services during 2015-16 for financial, efficiency or value reasons.

Thirty-four said they had introduced or approved restrictions out of the 188 groups that responded, while 33 said they were considering them.

Commissioners have started rationing access to services with “limited clinical value” in their patches, such as surgery for sleep apnoea, acupuncture and NHS hearing aids.

One HSJ reader was not in favour of local restrictions: “If a treatment is of ‘limited clinical value’ in Essex, it should be of limited clinical value in Manchester, Bristol or Leeds.”

However, others argued that rationing services is “what commissioning is”.