HSJ’s must read stories and debate from Friday

Holding the accounts to account

One of many lessons from Carillion’s collapse is to keep an eye on an organisation’s cash position, no matter how healthy the accounts look.

There have been rising concerns about the cash levels within the NHS over the last year, which seems out of sync with the reported financial improvement.

One thing accountants point to is “depreciation”, which is an accounting mechanism intended to spread the cost of assets over their lifetime.

If insufficient charges are made on depreciation (which is a bit like setting cash aside for replacing things that wear out), this creates a problem in the future when a building or piece of equipment comes up for renewal.

The Department of Health and Social Care’s annual accounts reveal an interesting trend on depreciation since 2011-12, with rising “underspends” against plan. Meanwhile, NHS trusts’ depreciation spend has been gradually dropping.

It may well be that the figures represent legitimate adjustments to asset valuations and expected asset lives (which would result in lower depreciation charges), but the DHSC declined to explain the reason for the underspends.

Critical warning

The Royal College of Surgeons has warned there may be too few critical care beds in England to cope with demand.

The warning comes as official data shows several trusts had 100 per cent critical care bed occupancy in quarter three of 2017-18 – the second year in a row this has happened for some trusts.

NHS England data on bed occupancy rates for 2017-18 showed only a small year on year increase, but masked that some departments were full in quarter three both this year and in 2016-17.

The largest trusts have significant problems with high occupancy rates. Five of the 20 worst performers in quarter three of 2017-18 were Shelford Group trusts: University Hospitals Birmingham Foundation Trust; King’s College Hospital FT; Manchester University FT; Oxford University Hospitals FT; and Guy’s and St Thomas’ FT.

The 20 trusts with the highest occupancy rates manage 20 per cent of England’s 4,060 critical care beds.

The RCS said the pressures on beds from patients coming through emergency departments was leading to cancelled operations.

Senior vice president Ian Eardley said: “The NHS has struggled through a very difficult winter, and while A&E has borne the brunt of the pressures, patients waiting for planned operations have been affected too. Surgeons are concerned that hospitals are struggling in part because cuts to beds have gone too far. That critical care bed capacity at some hospitals has been at 100 per cent consistently for the last three months is very worrying and reflects lack of capacity.