Read Jack Serle's latest HSJi Review, which discusses how the requirements for integrated care boards to simultaneously halve their running costs while restructuring themselves to become “strategic commissioners” are perverse. Read the full article here.

Latest Investigations

Greater Manchester Mental Health Foundation Trust

Greater Manchester Mental Health Foundation Trust’s breakeven plan is underpinned by £9m deficit support funding. Leaders must deliver a £32.5m efficiencies plan, with 82 per cent in recurrent savings. The trust focused on ending reliance on temporary staff spending and shifting towards e-rostering across the organisation. The shift to the electric vehicle model is expected to help deliver non-pay savings, as well as centralising IT licences to eliminate hidden costs. GMMH has entered a £20m regional risk-share agreement to help tackle inappropriate and high cost out-of-area placements. The trust faces challenges, despite exiting the national Recovery Support Programme in November 2025. Patient flow is stalled by delayed discharges and insufficient capacity in the community. Trust is embarking on a major reconfiguration of rehabilitation services to resolve systemic challenges. GMMH is planning to procure a shared electronic patient record with Pennine Care FT and move towards a “digital by default” model.

Leicester, Leicestershire, Rutland and Northamptonshire ICS

Leicester, Leicestershire, Rutland and Northamptonshire Integrated Care Boards are the two small ICBs which are forming a cluster and have appointed a joint board. Its transition and transformation committee is overseeing the clustering arrangements. The ICBs must reduce the combined £53m running costs by £16.7m and lose around 600 WTE staff. It is consulting on whether to consolidate some functions on a larger East Midlands scale. ICBs are being pushed towards “strategic commissioning”. LNR has developed a cluster-wide plan, which is to be finalised in mid-February. It will focus on three areas that came out of its research: frailty, children and young people and premature mortality. The cluster is planning to launch a major lung screening programme this spring. West Leicestershire was chosen as one of the national neighbourhood pilot sites.  Leicestershire Partnership Trust and its director of strategy, David Williams, will lead this work and will be based on the principles in the strategic commissioning plan. Although integrated neighbourhood teams have been in place in various guises across LLR for a while, the exact number of neighbourhoods is still being finalised, but in Northamptonshire, there will be. Within this, two of the neighbourhoods – Wellingborough and Rural East and South Northamptonshire – have been selected as pilots for Northamptonshire, as part of the New Models of Care programme.

Medicines optimisation priorities and problems in 2026

Spend on hospital medicines tops primary care for the first time. Cancer drugs are the largest area of hospital prescribing. The largest subset are drugs that must be produced in aseptic pharmacies. The NHS continues to struggle for aseptic production capacity. NHS England has set out priorities for medicines optimisation. The use of best-value biologics is the most popular option, and next comes standardising aseptic product formulations and addressing inappropriate prescribing of antidepressants. The plans to move the responsibility for medicines optimisation away from ICBs to trusts and neighbourhood health providers are progressing more slowly than originally planned. In the meantime, cuts to ICB running costs are impacting their ability to deliver on optimisation priorities.

Data Points
The following data points were updated this week:

• E-COLI HOSPITAL-ONSET CASES (12-MONTH ENGLAND AVERAGE), E-COLI HOSPITAL-ONSET CASES (12-MONTH REGIONAL AVERAGE), E-COLI HOSPITAL-ONSET CASES (12-MONTH ROLLING COUNT), MRSA hospital-onset cases (12-month rolling count) and C-Diff hospital-onset cases (12-month rolling count) for Acute in November.
• A&E waiting target, Beds occupied by delayed discharges and Length of delayed discharges for Scotland in December.
• Red emergency responses arriving within 8 minutes (%) for Wales in Q2 2025-26, Q3 2025-26.
• Specialised Services Income for Acute,Sp,Com,MH in 2025-26.