The must-read stories and debate in health policy and leadership.

There has been major consolidation of the NHS provider sector in recent years, suggesting that in the current context at least, there are benefits to creating larger organisations. 

The process of welding two hospitals together is difficult, however, and often controversial. 

Liverpool University Hospitals, which was formed through the marriage of the Royal Liverpool and Aintree hospitals in 2019, has found it particularly challenging.  

The trust has been beset with problems following its creation, coming under heavy criticism from regulators during the pandemic and having to replace its executive team. There have also been high-profile problems with merging some services, such as gastroenterology. 

But even specialties which kept their pre-existing configurations have struggled, such as pancreatic cancer. 

An internal report suggests a series of deaths and safety incidents within the specialty over the last two years were partly linked to patient pathways being ill-defined following the merger. 

Despite there being no formal plans to change the configuration, which already operated under a “hub and spoke” model, the report suggests there was an “expectation” within parts of the service that all the care would transfer to the Royal Liverpool hub site.

Break even or break promise?

Just over three months ago NHS England got the vast majority of the 42 integrated care systems to sign up to breaking even over the current financial year.

A bit of thumbscrew twisting and extra cash to help with inflation saw all but five ICSs submit financial plans in late June signing up to NHSE’s grandiosely titled “new joint legal duty” to break even. The recalcitrant systems which could not make the sums add up faced additional controls over their spending as a result.

Yet a few months on, the requirement looks rather toothless. Analysis by HSJ has found two in three ICSs are already falling behind their financial plans and starting to rack up big deficits.

Most of the systems are still bullish about their chances of balancing the books by the end of the year but one finance director cautioned that the break-even agenda had “put every system automatically in the red before they started”.

The figures were described as a “real worry” by King’s Fund chief analyst Siva Anandaciva, who warned that, while the NHS might be able to find money to bail out systems this year, the next financial year looks increasingly bleak.

Also on hsj.co.uk today

In London Eye, Ben Clover says that systems are having to correct earlier optimism on finance and looks at north east London, where the deficit at the end of month five was £53m, rather than the £5m it had planned. And in news, we report that a troubled trust’s inpatient wards for people with a learning disability or autism have been rated “inadequate”, with staff criticised for resorting to restraint too readily.