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

Sharing the risk

Greater Manchester has justifiably been grabbing most of the attention in recent years for how it is transforming NHS and social care services, but significant progress is also being made in Liverpool.

The organisational and service changes in the Healthy Liverpool programme, in which two acutes and one specialist trust are likely to be merged, will feed most of the local headlines.

But reaching consensus on the finances could prove to be just as important.

In what represents a significant shift away from the payment by results tariff, and the perverse incentives that go with it, six NHS trusts in the city have signed up to block contracts worth a combined £1.5bn over the next two years.

The providers will receive 1 per cent real terms growth in 2017-18 compared to their outturn income in 2016-17, with another 1 per cent increase the following year.

There are risks involved, of course, and we’ll have to wait to see if the contract is workable, especially for the two acute trusts.

But it’s hard to see why the risks would be any greater for the health system in the round, as the overall funding envelope is still the same, and at least now all the partners will be pulling in more or less the same direction.

There were plenty of people who balked at the tight deadlines involved in the current contracting round but – in Liverpool at least – the increased urgency appears to have helped focus minds and delivered an ambitious and progressive contract.

The dear old Act

One thing not being spoken about within the NHS is the potential legal snag, as some experts believe moving to block contracts breaches the terms of the dear old Health and Social Care Act 2012.

But without any prospect of further legislative changes in the short to medium term, local leaders must feel like they have no option but to plough ahead, so long as they have the backing of NHS England.

Black alert

The first week in January brought the now traditional surge in activity at accident and emergency departments, and more than half the acute trusts the North West reported major pressures, or what used to be known as “black alerts”.

The Royal Liverpool and Southport hospitals were among the six nationally which reported the highest level of operational pressures (OPEL 4), which denotes that staff are unable to deliver comprehensive care and an increased risk of patient safety being compromised.

Contract notice

The A&E pressures also have a major impact on North West Ambulance Service Trust, which despite being one of the better performing ambulance trusts, has still been served with a contract notice in relation to recent waiting times.

The average turnaround time at A&E has increased to 35 mins in recent months, compared to 30 minutes in the same period in 2015.

The recent numbers look particularly bad at the Royal Bolton and Stepping Hill hospital in Stockport.

Row back

Many commissioners in the north were furious at late changes to clinical commissioning group allocations by NHS England last month, which were made in relation to the new national tariff.

The adjustments equated to a £75m cut in allocations to CCGs in the north, while those in London got an extra £24m.

The national body claimed the new tariff prices will neutralise the changes, but this failed to quell suspicions of a sneaky north-south shift in resources.

Eventually NHS England was forced to row back by softening the reductions by 50 per cent, but this could still cause serious problems, particularly for CCGs in Lancashire.

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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