Your essential update on health for the week

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Mackey leaves with a bang

The man with two hats has taken one off.

Jim Mackey had a lot to say as he headed back to Northumbria to run his trust, leaving NHS Improvement and his role as national overseer of the provider sector.

He told HSJ there should be “ruthless” consolidation of NHSI, NHS England and local commissioners, and that this could save £1bn.

(London has taken some steps in this direction, appointing a “head of winter” who is a joint appointment across NHSI and E. And in a sign of the importance of the role of NHS England London, it has been helmed by NHS England nursing director Jane Cummings on top of her day job since September.)

The billion would go some way to sorting out the provider deficit (estimated at £4bn in some quarters).

But would it help the service manage?

On Sunday, the chair of King’s College Hospital Foundation Trust Bob Kerslake resigned, saying the financial position NHSI and the government had put the trust in was impossible.

On the national level, Mr Mackey said the speed with which the provider deficit could be cut was the subject of “very unreasonable expectations” from the government. But he also stressed that the NHS must prove itself worthy of the extra it was given.

On the regional level, similar criticism of the government and NHSI was made by Lord Kerslake.

Council chiefs take over

The sweeping away of clinical commissioning groups continues apace in Greater Manchester, where the leadership of four more CCGs is set to be merged with that of the corresponding local council.

HSJ has learned that in Trafford, Rochdale and Oldham the council chief executive is expected to take over the CCG accountable officer role on a dual basis. Wigan CCG has also confirmed its intention to merge the two roles.

The odd one out so far is the city of Manchester CCG, which confirmed that Ian Williamson will stay on as chief officer and heading up Manchester Health and Care Commissioning, which has been established through a partnership agreement with the council.

The future shape of ACOs

“They could call it a primary care trust” was the reaction of a number of readers to news that new NHS organisations – potentially taking a new form – may be created to house the NHS’s first “accountable care organisations”.

Combining a commissioning budget with prevention, provision of community services and close relationships with general practice was indeed close to the original intention of PCTs.

What PCTs did not achieve though was breaking down the wall between general practice and the rest of the NHS.

Creating new trusts or foundation trusts will likely be justified only if this can be achieved.

People are rightly tired of structural change but it’s part of a reshaping of the NHS landscape that might, unfortunately, be needed.

Winter gloom and glad tidings

There were more discouraging A&E figures released on Thursday, but HSJ has an early Christmas present for those looking for solutions.

Let HSJ editor Alastair McLellan explain:

“We report exclusively on the initial findings of the centrally funded Improving Access to Psychological Therapies programme, which brings mental health support to those with long term conditions.

“The most robust findings, from Cambridgeshire and Peterborough Clinical Commissioning Group, show a 61 per reduction in accident and emergency attendance in the cohort of patients accessing the integrated IATP services – 61 per cent. Just let that sink in.

“The impact on GP visits (down 73 per cent) and inpatient admissions (down 75 per cent) was even greater.

“If this was not reason enough for the NHS to find every way it can to invest in mental health there is also growing evidence that poor mental health is an even bigger driver of cost to the NHS than age or chronic disease.

“It is an argument that should convince even those whose focus is on the service’s bottom line.”

The ghost of

Tensions over who controls NHS patient data (and to what purpose) are rising again, with the national data guardian, Dame Fiona Caldicott, raising the specter of as a warning to the government.

The defunct, controversial data sharing scheme, finally scrapped in July last year, casts a long shadow.

The government has only recently started ramping up efforts to create a new patient data sharing scheme.

However, Dame Fiona raises two important risks to any new scheme.

First, the government must involve the public in deep and wide conversations about the level of control they will be given over their data (the “national opt out scheme”).

Second, carving out too many datasets where patients will not control their data risks undermining the credibility of the entire project.

Keep it 100

After the political upheaval of the summer, the HSJ100 wears a more settled look – but appearances can be deceptive.

The same five individuals occupy the top spots in the 2017 HSJ100 as did in the refreshed rankings produced after the general election, but their interactions will be very different, as the editor explains.

The 100 is a ranking of those people who will exercise the greatest influence over the English NHS and health policy between now and November 2018. Established in 2005, the power list is judged by some of the most knowledgeable and experienced figures in healthcare leadership.