North by North West: Mad fer mergers

More change in the devo capital

Another week, another merger plan in Manchester.

Not satisfied with creating a giant acute trust and a single provider for all out of hospital care by April 2017, now the city’s three clinical commissioning groups have committed to their own merger by the same date.

Only six months ago, CCG leaders were saying they were a few years away from merging the organisations, but things change pretty quickly in the devolution capital.

A glass-half-empty commentator might suggest this represents another pointless reorganisation that simply reverts back to the previous arrangements under the primary care trust (there was one PCT for Manchester until 2013).

But I’d call it another sensible unravelling of the much reviled and increasingly ignored Health and Social Care Act 2012.

The timescale for all the three mergers look extremely ambitious, however, and one legal expert told me there was next to no chance of completing all of them on time.

But don’t talk takeover

Regular readers will be well aware of Manchester City Council’s sizeable influence on health matters in the city, and this will be formalised through the creation of a “single commissioning function” between itself and the newly merged CCG for all health and social care services.

Local leaders have been understandably anxious to avoid talk of a “council takeover” of NHS commissioning. But I wouldn’t be surprised if we start to see more senior roles starting to span the two organisations, when the logical step could eventually be for the joint commissioning body to transfer into the council’s structure (legislation allowing).

As reported last month, Tameside and Glossop seem to be headed in this direction at an even faster pace.

Meanwhile, the influence of local government over NHS matters seems to be catching on across the North West, with Mike Wyatt being appointed interim recovery director at the troubled St Helens CCG.

Mr Wyatt will continue in his role as strategic director of people’s services at St Helens Council and will work to “further develop closer integration between the local authority and the CCG”.

A&E recovery

Six acute trusts in the North West will be given another year to meet the national four hour standard for emergency services.

Along with about half the acute sector, Bolton Foundation Trust; Lancashire Teaching Hospital FT; Mid Cheshire Hospitals FT; Royal Liverpool and Broadgreen University Hospitals Trust; Wirral University Teaching Hospital FT; and Warrington and Halton Hospitals FT will again be given “improvement trajectories” by NHS Improvement for 2017-18, rather than being required to meet the 95 per cent target from April next year.

But judging by the recent stats, there are a fair few others that are likely to need a bit longer, and will have to make their representations to NHS Improvement.

There was an interesting point raised in Liverpool CCG’s September board papers around the 95 per cent standard, and the question of whether walk-in centres should be included in the performance stats.

Counting only the “type one” A&E departments at the Royal Liverpool and Aintree, the year to date performance was around 76 per cent. But then factor in the near 100 per cent performance at the walk-in centres, and the overall figure jumps to about 89 per cent between the trusts.

Recent correspondence with NHS Improvement confirmed the walk-in stats should be included for performance reporting against the “sustainability and transformation fund” requirements, which is clearly good news for Liverpool.

This might seem unfair on trusts such Tameside or Bolton, which must rely on type one data alone, but perhaps this is just reward for those health economies that have successfully introduced walk-in centres to ease pressure on their emergency staff?