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

Julian Kelly, the man responsible for £170bn of public spending on the health service, was on optimistic form when he spoke to HSJ last week.

NHS England’s financial chief said he was “more confident” in the current year’s financial plans than he was this time last year, despite a higher number of integrated care systems forecasting deficits. Mr Kelly said he expected “a lot more” to hit their financial targets.

In another indication of apparent confidence, Mr Kelly denied he was holding back some funds to plug budget gaps that might emerge later. “I am not planning now… for people not delivering on plan,” he said.

This can perhaps be attributed to finally arriving at local NHS plans that are politically acceptable. Earlier iterations had thrown up national deficits as high as £6bn, now slashed to a more palatable £650m.

The rosy picture painted by Mr Kelly may not be shared by local finance leaders, who worry that the one-off funding streams and covid cash reserves used to get through last year have now been exhausted. And the rising number of ICSs that cannot breakeven – 15, as opposed to five at this point last year – is hardly cause for optimism.

Sadiq steps in

Expect to hear more about the battle over who runs paediatric cancer services in south London over the coming months.

The struggle over whether the principal treatment centre is at St Thomas’ (zone one) or St George’s (zone three) comes after NHSE ordered they be co-located with a children’s critical care unit, without exception.

And for years the Royal Marsden’s centre in Sutton (which transferred kids who needed that care to St George’s in an ambulance) was that exception. HSJ brought to light how previous efforts to improve the situation came to nothing.

So the choice now is between expanding services at St George’s to host the cancer work or doing the same at St Thomas’. The NHSE assessment put the latter ahead in an assessment, the details of which have never been made public.

The public consultation starts this month. Perhaps this will provide some clarity on the financial implications (the Tooting camp believe theirs is the cheaper option), but perhaps more significantly on the process that put St Thomas’ ahead.

St George’s believe the process so far hasn’t taken account of their long experience of delivering children’s cancer services. Problems with process are the kind of thing judicial reviews get brought over.

The mayor of London’s position is not yet known, but he doesn’t routinely commission independent reviews of NHS reconfigurations.

Services won’t move until 2026, NHSE says. If previous specialist reconfigurations are anything to go by, they may not move at all.