While Labour’s integration policy is hard to pin down, our best interpretation is that over time CCGs would become subsidiary to local authorities’ health and wellbeing boards.

Liberal Democrat policy is not dissimilar, and health secretary Jeremy Hunt has told HSJ he wants pooling of CCG and local government funding to be “accelerated and extended”.

‘Many CCG leaders say they would walk out’

More significant still is the non-political move to develop integrated, accountable providers, which could ultimately take on devolved health budgets for their population. Widespread adoption of this would leave scant justification for CCGs.

The HSJ/Capsticks clinical commissioning barometer finds CCG leaders hostile to centrally driven restructure and to a default position of putting local authorities in charge.

Many say they would walk out if this took place; politicians flirting with such an approach should consider the impact of losing yet more senior expertise.

Appetite for upheaval

More surprising is how many CCG leaders have an appetite for further organisational upheaval, provided it is flexible and locally instigated.

‘What is needed is more focused and coordinated experimentation’

One CCG leader writes that HWBs need “massive development if they are to take on a broader role”, but putting them in charge would be “a good outcome if they were able to step up to the job”.

About a quarter believe their area will soon follow Greater Manchester’s lead on large scale devolution and integration.

But the findings also reveal a high level of uncertainty about the potential impact of closer joint working: 29 per cent say they don’t know if services would be better integrated if HWBs held the reins; 24 per cent don’t know if NHS service quality would be damaged; and 37 per cent don’t know if prevention would be improved.

This suggests what is needed - whatever the politics after 7 May - is more focused and coordinated experimentation.

The barometer shows CCGs’ confidence is still high. But if the big questions about their future are not addressed, these groups will wither, as more of their leaders jump ship.

Manifestos are quiet on funding implications

The health secretary’s interview with HSJ last week confirmed that the Tories’ welcome pledge of an £8bn-plus real terms increase for the NHS is not backed by detail about how it would be funded.

‘There will likely be a more ruthless focus on finances post-election, whoever forms the next government’

Jeremy Hunt also gave a strong steer that part of the £8bn would be expected to subsidise social care.

What is absent from the Conservatives’ manifesto, as from others, is a clear signal of what the funding climate will mean for the service.

In the past two years Mr Hunt has overseen an approach that has effectively tolerated growth of NHS deficits in favour of efforts to maintain access standards and quality.

This is likely to give way to a more ruthless focus on finances post-election, whoever forms the next government.

Forecast shortfalls

Finance directors are rumoured to be predicting untenable cash shortfalls in 2015-16.

Former NHS chief executive Sir David Nicholson has predicted “emergency measures” to curtail spending in coming months.

‘It will come as little surprise if the Treasury has to pump extra funding into the service’

CCGs report they are extending access constraints.

Workforce productivity, and service and organisational consolidation will also be on the agenda.

Given that all this is unlikely to save enough, quickly enough, it will also come as little surprise if the Treasury has to pump extra funding into the service this year, despite Mr Hunt’s view that the government has already “done its bit” in terms of extra funding for 2015-16.