A good story here from Pulse on the potential savings in London from 'polysystems'. Or rather, the potential lack of them.

As I've previously blogged already today, double-running costs are just not going to be viable. NHS London has realised that the hearty and well-established nettle of London healthcare reform has got to be grasped.

And as John Lister's On The Brink report (commissioned by the BMA - full version here) observes, "London’s health services are headed towards a major financial and organisational crisis".

The potential savings from providing services outside acute settings will not be offset by realisable reductions in the costs of running acute trusts. In deficit terms, this is 'pass the parcel-bomb' territory.

This is vital stuff, to deliver clarity on how the transition of care out of acutes will be managed. Is there to be a national levy across SHAs (from their top-slicing) to fund the change? Who will fund the redundancies?

The On The Brink report correctly notes that not all parts of the capital can easily close much acute capacity. South-west London (COI declaration - I live there) doesn't have too much that you can realistically close.

In the absence of the information about who pays for what to close and how, polysystems are just going to show more cracks. And Polyfilla will only get you so far.