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Leaders are already thinking about what their organisations must do to deliver the best possible health outcomes In just two weeks, clinical commissioning groups take up their full responsibilities as we shift from a managerial to a clinical commissioning-led system for the NHS in England. While clinical commissioning may be on a developmental journey, as leaders we are already thinking about the skills we need to do the day job, some of the challenges we will face and how we can overcome them to make sure that our patients, our people and our practices deliver the best possible health outcomes...

As a judicial review begins on proposals to close a number of units, Roger Boyle says pooling surgical expertise is a vital move Advances in medicine mean that many young babies with congenital heart disease are alive today who would not have survived treatment in the past. In fact most are going on to school, making friends and living into adulthood. But, with change, expert surgeons and their teams can save even more lives and prevent some of the life-long conditions, such as brain damage, that some children face after surgery. The landmark decision to improve children's heart services by...

St Helens and Knowsley's initiative could become a model as the government pushes to put patient records online by 2014 A teaching hospital in the north-west of England claims it was the first NHS trust in England to become paperless. A year ago, St Helens and Knowsley put the last of its 500,000 patient records on line after spending the previous three years working closely with 88 local GP practices and two other trusts. The first step the trust had to decide was what it wanted a digitalised system to achieve. The new system two requirements: to scan paper records and be able to collect live...

The watchdog has been making serious efforts to restore professional confidence, but news that it may appoint a former Conservative party chief executive as its chair is concerning The Care Quality Commission is the public bulwark against neglect and abuse in health and social care. That's why the announcement that a Tory MP and former chief executive of the Conservative party, David Prior, is the government's "preferred candidate" for its chair raises concerns. It isn't as though the CQC is currently in a comfortable place, inspiring professional and public confidence. Instead...

Newly published Dr Foster Hospital Guide shows lack of integrated care leads to overcrowded A&E departments In March this year, the Department of Health published the evaluation of the national integrated care pilots launched in 2009. The results were disappointing. The hoped-for reduction in emergency admissions to hospital had not occurred as the result of many varied attempts to better integrate social care, primary care, community care and secondary care. Undeterred, last month the health minister, Norman Lamb, announced that a new wave of national pilots would be funded. The announcement...

There are signs local authorities will forge closer relationships with CCGs than they might have done with primary care trusts During this time of transition as public health moves into local government and GPs into clinical commissioning groups (CCGs), both sides are bound to bring some historical challenges to the meeting table. The NHS is a big, relatively well-funded organisation that historically does not always have a great record at looking outside itself. Local government, by comparison, is very externally focused. Some councils may have scars from earlier attempts at engaging with an NHS...

Following a conference on Telehealth, the Patient from Hell argues that clinicians who have tried it are quickly converted Dr Paul Rice summed up the HSJ's Telehealth 2012 conference last month with what I suspect is an old NHS chestnut, but I had never heard it before. It goes like this: "Managing change in the NHS is like dancing with a gorilla. You don't stop dancing when you are tired. You stop dancing when the gorilla is tired." Paul Rice should know. He is the director of Yorkshire and Humber Health Innovation and Education Cluster , and has been dancing with the gorilla...