Essential insight into England’s biggest health economy, by Ben Clover.

Everyone expected some news on London devolution a little while ago.

What it would cover; when it would start; whether it would, actually, mean anything?

Now it appears there may finally be an answer, on timing at least: an announcement is expected in November, and maybe before the budget.

It is still not clear what it will actually do, but there have been five pilots overseen by the London Health and Care Devolution Programme Board, which reports to the mayor’s office.

At a recent policy event organised by the Westminster Health Forum, a number of the problems to getting anything devolved in London were outlined.

First, London is a bit more complicated to devolve than Manchester (which, to be fair, has some actual power now).

North west London sustainability and transformation partnership patch is more populous than the whole of Greater Manchester for a start.

Second, the landscape is littered with bodies.

I’ll list them here or you can take my word for it, scroll down and I’ll see you in a few lines’ time. Deep breath, there are: clinical commissioning groups; GP federations; London-wide local medical committees, health and wellbeing boards; 33 local authorities and their health overview and scrutiny committees; London councils; NHS trusts and foundation trusts (and their councils of governors); five STPs; two cancer networks; the trauma network; the stroke network; three academic health science networks; four academic health science centres; the regional arms of the Care Quality Commission, NHS Improvement and NHS England; universities; a commissioning support unit; private companies providing commissioning support services; private companies providing NHS funded care; community interest companies providing community services; social enterprises providing community services; housing associations; and charities. Plus, the mayor’s office.

There is often distrust between the different types of organisation. The forum heard about a council using public health money to fill potholes, and that STPs and accountable care organisations/systems were considered tainted in some quarters.

Primary care voices seemed to feel a lot closer to local government than they did to the big NHS providers. Fine, but those trusts run significant chunks of community services.

It was pointed out that while appointing one accountable officer for all the CCGs across a whole STP area was exciting, it was a de facto reorganisation and risked losing another 12-24 months’ worth of productivity gains.

So why bother? Especially when the National Audit Office’s director for local government, health and education said there was no evidence better integration saves anyone any money.

Lewisham CCG chair Marc Rowland provided the answer in his talk: integration is the right thing to do for patients.