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

Money talks

The government has committed £20.5bn real growth to the NHS and, as many have noted, will want its pound of flesh. Thus far, that price appears to be a few sketchy press releases.

Theresa May previewed cancer commitments from the NHS long-term plan at the Conservative party conference, Philip Hammond brandished an “at least £2bn” for mental health ahead of his Budget last month; and this week it was decided that £3.5bn was an appropriately big number for the prime minister to commit to primary medical and community health services.

These announcements can do little in material terms, and the big numbers don’t mean a lot, but they can send the signal of what government wants – for whatever that is worth these days.

It appears the general intention, in addition to getting a modest PR hit amid the Brexit maelstrom, is to tip the balance – as the health service goes about spending the new cash – towards reform, prevention and transformation.

The announcements will probably manifest in the NHS long-term plan as promises to increase the share of spend going on mental health, primary medical services (note: not community pharmacy or dentistry) and community health.

Perhaps the most definitive comment in recent weeks was that of Matt Hancock who said primary and community spending should increase its share of the pie next year – a year when money will be very tight, and when trusts and their supporters would like to see their own financial recovery prioritised.

None of the promises will count for much unless they are backed up by robust behind the scenes decisions on carving up budgets, channelling spending flows, and securing staff. Transparent accountability might help too – information about spending on different services has been terrible in recent years, leading to confusion about whether these announcements are in fact ambitious, or entirely underwhelming.

National NHS leaders are meeting imminently, in the final stages of writing the NHS long-term plan, to apportion cash to its priorities. Planning guidance, funding rules, allocations and contracts are in the mix too, dictating the real shape of the next few years.

Speaking of money

Commissioners in Staffordshire have revealed their bottom lines will sink £27m into the red – despite agreeing to a surplus control total at the beginning of the year.

In recent board papers, North Staffordshire and Stoke on Trent clinical commissioning groups said they are set to miss their £6.6m control total by just shy of £35m.

What has happened to the CCGs’ finances between agreeing their control total at the beginning of the financial year and now? Both commissioners ended 2017-18 in the black, albeit not by a substantial sum, so it seems surprising they have shifted so much in the other direction in just six months. 

A couple of readers have suggested the commissioners may have attempted to shore up their own financial position by fining University Hospitals of North Midlands Trust, which has its own deficit of £40m to address. This is in response to claims from the trust that the level of contractual challenges from the CCGs had become “unsustainable”.

Whatever the reason, with most of the region’s providers and commissioners currently running a deficit, leaders will be weary of frayed relationships at a time when they desperately need them to be strong.