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

STPs on the back foot

Blanket media coverage of the sustainability and transformation plans caught national NHS leaders on the hop last month, with the narrative now framed in the context of budget cuts and service closures.

This makes life difficult for local organisations once local media starts following up the story.

Leaders in Merseyside and Cheshire could be set for a particularly rocky ride, after the Liverpool Echo went big on the “swingeing cuts” needed across the region last week.

Of course, the merger of the city’s two teaching trusts, the Royal Liverpool and Aintree, has long been on the cards, along with the relocation and possible takeover of Liverpool Women’s Foundation Trust.

But it now looks likely that these mergers will (perhaps this was inevitable anyway) be seen first and foremost in the context of the financial black hole, when local leaders will have wanted to see a strong clinical case put forward and lodged in the public’s mind.

Maybe there are lessons here for Lancashire and South Cumbria, where plans are perhaps not so advanced and there are still opportunities to get on the front foot and shape the narrative.

Greater Manchester seems to have managed this reasonably well (there have been plenty of decisions that could have courted huge controversy), though the job has arguably been easier thanks to the alternative narrative offered by devolution.

CCG chief straight to the point

Back on Merseyside, St Helens Clinical Commissioning Group announced the departure of accountable officer Steve Cox last week, after he handed in his resignation.

The CCG was rated inadequate by NHS England in July due to concerns over finance and planning, and also hit national headlines in August by proposing to freeze all non-urgent referrals to secondary care for four months.

The plans to freeze non-urgent referral were dropped just a few days later due to “feedback received”, though several other rationing measures are still being pursued to try to mitigate a £12m funding gap.

The CCG said Professor Cox wanted to focus on his general practice work and academic interests, while a statement issued on his behalf was unusually brief and to the point: “I wish the CCG every success in the future, in particular in managing the current financial challenges.”

CCG finances across the country are showing serious signs of stress, but as in St Helens, any proposals to seriously start rationing care will undoubtedly bring major controversy.

Some CCG leaders might wonder whether controlling the finances is really within their power.

New figurehead for devo

A change at the top of a local authority is not normally of great interest to HSJ, but it is when it’s in Greater Manchester.

Sir Howard Bernstein, longstanding chief executive of Manchester City Council and a key architect of the GM devolution deal, announced his retirement last week.

The fact this is significant to health policy is indicative of the rapid changes taking place in the region, with CCGs seemingly morphing into departments within their local authorities.

Sir Howard’s departure next April is likely to increase the influence of Jon Rouse, the recently appointed chief officer for the health and social care devolution project.

There is a risk here that “bottom up” devolution driven by local leaders will start to be seen as a “top down” process controlled tightly by national bosses.

Mr Rouse is an NHS England employee and former Department of Health official, so will want to demonstrate his independence and commitment to real devolution and local decision making.

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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