Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Crashing the devo party

Greater Manchester’s devolution project is still in its infancy and seeking to establish its influence in the region.

But just 12 months on from the launch of the Devo Manc, it’s entered a new phase which could potentially disrupt the planks of reform which have already started being laid.

Although Andy Burnham, who was elected the first ever mayor of Greater Manchester last week, will not have formal powers over the NHS, there is no doubt his democratic mandate will carry significant clout and leverage with health leaders.

While Sir Howard Bernstein, the recently retired chief executive of Manchester City Council, was incredibly effective at pulling strings behind the scenes, Mr Burnham will have a much clearer platform from which to exert his power. And as a former Labour health secretary, he is unlikely to show any lack of interest or eagerness to influence.

Which means politics – so often the scourge of perfectly sensible NHS transformation plans – could soon be getting much more attention at the devo party.

Some recent polling data published by Incisive Health suggested 77 per cent of people believe the mayor should oppose any future closure or downgrading of hospital departments, even if this leads to cuts in other public services.

Unsurprising perhaps, but still worth stressing. Because some of the region’s hospital departments are undoubtedly nearing an end of life plan, and will need to be consolidated.

The more specialist services should get a relatively easy passage from the mayor (if not the trusts that lose out), but things will get more difficult when attention turns to things like walk-in centres and consultant-led maternity.

And can Greater Manchester carry on sustaining nine full accident and emergency departments within a 10 mile radius of Piccadilly Gardens? (The 10th in Wigan is further out)

The units which are losing high risk and emergency general surgery as part of the Healthier Together process – especially Bury and Tameside – may well struggle to retain their type-1 status.

It will be crucial, therefore, for NHS devo chief Jon Rouse to build a strong relationship with the mayor, and to win his support (or at least acquiescence) for key changes to hospital services.

No devo

Likewise in Liverpool, major plans for reconfiguring services will go far more smoothly with new city region mayor Steve Rotheram kept onside.

From the sounds of it though, a Greater Manchester-style NHS devolution deal is not going to happen any time soon. Especially with the city’s sustainability and transformation partnership plans working along different geographic lines.

Breaking up CCGs

We should soon see the outcome of Deloitte’s review of the commissioning system in Greater Manchester, which was scheduled to last up to 10 weeks.

This review may just initiate the breakup of clinical commissioning groups as we know them – with some of their functions potentially being centralised into a strategic commissioner for the region, and the others staying local but effectively (to do it formally would need legislation) being merged into NHS trust or council structures.

Even if the recommendations aren’t quite so radical, it will be interesting to see how they go down in some of the outer boroughs.

Capping spend in Cheshire

Meanwhile, the latest attempt from national leaders to control NHS overspending means more work for Deloitte.

The firm has been commissioned by NHS England and NHS Improvement to conduct a six week review of the Eastern Cheshire and South Cheshire/Vale Royal economies.

This is part of the new “capped expenditure process”, under which Cheshire has been pinpointed as one of the health economies that need to scale back their unaffordable services.

The process also sets out a combined spending limit for the area, and says commissioners and providers must consider “how the resulting envelope for each area of spend will be broken down across the individual organisations”.

Hopefully these considerations will go more smoothly than the recent contract wrangles with Mid Cheshire Hospitals Foundation Trust and two CCGs – which required formal arbitration and meetings with Simon Stevens and Jim Mackey.

Miraculous recovery?

As part of our financial coverage of the nine-month period to December 2016, we highlighted a miraculous change in forecast outturn at Royal Liverpool and Broadgreen Hospitals Trust.

In its board report of 31 January, the trust said a “detailed review” of its forecast had been conducted and a “likely deficit” of £4.2m had been signalled to the regulator.

But then days later, the trust said the forecast was back on track for a £15.9m surplus – due to a significant increase in expected income from commissioners and extra incentive payments triggered as a result.

However, there has been no deterioration in Liverpool CCG’s financial position since January, so it’s not clear that they ever agreed to this.

Unusually, the trust’s month 12 board report said its financial data is unavailable “due to finalisation of year end position”. Perhaps things weren’t quite so straightforward as the trust had hoped.

Alternative bailout

Meanwhile, Blackpool Teaching Hospitals FT has managed to avoid the Department of Health bailout regime, by borrowing £9m from the local council instead. So the trust sidesteps the higher rates of interest charged by the DH.

Other trusts have tried this and failed, because the DH stipulates that those already in receiving interim cash support cannot try and borrow money from elsewhere instead.

So the council loan allows Blackpool to cling on to some of those FT freedoms.

North by North West takes an in-depth fortnightly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

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