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

So goodbye Jeremy Hunt, hello Matt Hancock.

Of course there are plenty of questions about national matters for the new health and social care secretary, but there are also implications for healthcare in London.

For a start – capital. Capital in the capital. Sir Robert Naylor did two reports on NHS Property, only one of them was released.

The second one is on what could actually be sold/co-developed to allow some real transformation in the way health services are provided in London.

Under Mr Hunt it seemed clear this second report would never be released because the ideas in it were too controversial.

Nevertheless, Imperial’s £1bn-odd in backlog maintenance is not going to un-crumble itself, so perhaps the newcomer will release this report.

A national question that will apply heavily to London is the approach and tone adopted in dealing with favoured trusts and those that are seriously failing.

For example, although Jeremy Hunt completed the liquidation processes for Mid Staffordshire Foundation Trust and South London Healthcare Trust, he did not begin them.

The case against South London Healthcare Trust was mainly financial (quality was never convincingly proven to be an issue) and if Mr Hancock decided he was going to be more interventionist than his predecessor the same sort of case could easily be made against King’s College Hospital FT. This south London trust is running a deficit roughly twice the size of SLHT’s when it was dissolved.

(But, as a Shelford Group trust, dissolving it would be a much more consequential move than breaking up an unloved amalgam like SLHT).

Mr Hunt, speaking about the implications of the Health Act 2012, has previously told the King’s Fund he would be surprised if the Monday morning meetings with the chief executives of the national bodies did not continue after he left. Will the Monday morning calls to embattled provider trusts?

So we will see how interventionist Mr Hancock will be towards the provider sector.

London trusts have figured significantly in these discussions recently.

At the other end of the scale, Mr Hunt had his favoured London organisations who were encouraged and supported in their ambitions to run large chains, either by cooperation with or acquisition of less favoured organisations. Notably last month’s big NHS spending announcement by prime minister Theresa May took place at the Royal Free, despite the trust’s significant deficit and interesting relationship with its charity.

Mr Hancock inherits a cash-strapped system, so it is unlikely he will be completely hands-off.

What does this mean for devolution plans in London?

The new health and social care secretary takes control of an NHS that has been operating substantial work-arounds for some time, his attitude to these, as well as to the incumbent individual system managers, will be key to London and the rest of the NHS.

Pathology

In other news, London Eye understands that in some parts of London there are murmurs of dissent about pathology networks.

NHS Improvement’s national pathology team might be accused of perhaps not always grasping the totemic significance of pathology labs to a hospital’s sense of self. Many senior clinicians regard a hospital without the full array as perhaps not a proper hospital at all.

So plans that might make sense on paper, or on a map of sustainability and transformation partnerships, are less appealing to staff on the ground. Staff who may have had their own plans fairly well worked out.

If anything, London has been quite restrained on fighting pathology centralisation, compared to other regions.