Policy makers would have us believe the reforms are all about changing patient pathways rather than building new structures, but announcements on structural change are coming thick and fast.

In the East Midlands, most primary care trusts are expecting to separate their provider arms in time for the 1 April transforming community services deadline, but the strategic health authority has noted “risks” regarding the ability of NHS Leicestershire and NHS Northamptonshire to do so.

Four service reconfigurations are planned, although only two - changes at Skegness Hospital and a “downgrading” of Newark Hospital’s accident and emergency unit - have been signed off.

Proposals to merge a walk-in centre and A&E, to sit alongside emergency departments at Sherwood Forest Hospitals and Nottingham University Hospitals, are due to be discussed by NHS Nottinghamshire County this week.

NHS East Midlands is tendering for “external support” to bolster a review of trusts’ preparedness for foundation trust status.

The region has six aspirant foundations and two aspirant community foundation trusts. Derbyshire Community Health Services and Lincolnshire Community Health Services have had their applications approved by the Department of Health and are awaiting final approval from the health secretary.

NHS West Midlands has announced all five of its cluster chiefs: the chief executives of NHS Sandwell, Stoke on Trent, Worcestershire, Coventry and Walsall were successful.

Less happily, NHS Warwickshire was overspent by more than £2m with only two months of the financial year remaining.

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