What NHS England isn’t telling you, and more indispensable weekly insight for commissioners, by Dave West

The latest news out of Greater Manchester’s devo Manc project falls on the commissioner side, with the announcement that Tameside Council’s chief executive is also to serve as chief officer of Tameside and Glossop Clinical Commissioning Group.

A single commissioning board is already running between adult social services and the CCG, controlling a budget of £435m. Council commissioning teams have moved into the CCG offices and there are plans to create joint roles across finance, HR and other areas. On the provider side, social care staff are likely to formally move to the newly renamed Tameside and Glossop Integrated Care FT within 12 months; a similar move in Salford earlier this year saw 440 council staff transfer.

Similar shifts are taking place across Greater Manchester. Our North West correspondent Lawrence Dunhill writes that the three CCGs in the city of Manchester are now acting like a department within the city council.

A lot of noise has been made about what’s happening at the macro, regional level in devo Manc, but it’s more important to clock what’s going on in individual boroughs.

The tension between the local and regional is playing out in many patches around the country: a push from many in the NHS to scale up planning – often to the level of sustainability and transformation footprints – competing against the local pull of community, primary care and often municipal cooperation.

The decimation of much of councils’ budgets and functions means care services are ever more dominant for them, giving more rationale for clinging tightly to the NHS. Some in the health service see local authorities’ nosediving spending power as yet another reason to not play ball with them. For others, it is a chance to do deals, seize control of care provision, and try to ease pressure on hospitals.

Over in Birmingham – England’s second city in fact if not popular perception – three of its awkward clutch of CCGs are moving towards merger. This consolidation would take them a step towards matching the boundaries of the massive Birmingham City Council, but a bite would still be taken out of that patch by a fourth CCG, Sandwell and West Birmingham.

There is also new news of provider-side consolidation in Brum. University Hospitals Birmingham and Heart of England foundation trusts, which have been sharing a chair and chief executive since October last year, have announced they want to merge. Birmingham’s women’s and children’s FTs are merging too, and Manchester is developing a single, city-wide mega trust. These are reminders that, notwithstanding the flurry of novel “chain” and chief exec sharing arrangements, there’s a long history of hospital providers consolidating, and it’s not about to stop.

Some of England’s other big conurbations have room for trust mergers too, but are not seeing such quick movement (Liverpool and Bristol, for example). In the North East, several FTs are looking at much closer joint working but merger is not officially on the table.

The wave of merger and management cost cutting in trusts (assuming, given the huge pressure from above, that the latter is now happening) will in turn put even more pressure on the commissioning side to cut its own cloth. Provider voices have been quick to argue, “if we’re giving up independence to save overheads, so must they”. Most of the other side are readying themselves for just that, as I’ve covered plenty before.

What does this mean for big city NHS commissioners? Within London, the role of the five “sector” groups of CCGs (matching the STP footprints) gets stronger by the day. Leeds still has a three CCG split – I haven’t heard of a proposal to join, but surely it can’t be far away.

Some city CCGs already match their city boundaries (Liverpool, Bristol and Newcastle Gateshead come to mind) but might seek to spread wider across their “city regions” and/or expand borders by taking over at weak neighbouring groups.

Wherever the pull (and cost saving motive) of a move to bigger footprint takes hold, there will be resistance from local general practice, and potentially communities and local government, which will have to be balanced. The experiments in Greater Manchester’s boroughs will likely become a model response.

The Commissioner’s reading list: STP special

My last edition stated that it was time for STPs to be published. Some observers have tentatively disputed this, their main point being that some have lots of work to do to get them to a decent state, so they can’t be published. The centre will soon have to make clear its approval process, revealing whether all STPs – warts and all – are to shortly be deemed complete; or whether there will be later waves and/or a form of approval “with conditions” for laggards.

In the meantime, several STPs have published full draft plans. The sky does not appear to have fallen in on them. You might want to have a read:

Dave West, senior bureau chief

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  • Senior commissioning leaders are invited to the HSJ Commissioning Summit in September – a high level forum for debating how commissioning should develop, delivering STPs, and the financial climate. Confirmed contributors include Simon Stevens; NHS England’s new director for commissioning operations and informatics, Matthew Swindells; and Alberto De Rosa, chief executive of the Ribera Salud Group in Spain, whose model of accountable, integrated care is widely praised internationally. Get in touch via the website.

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