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

Accounting adjustments

NHS Improvement has always tried to put a positive spin on the provider deficit, but is now far more ready to acknowledge the underlying difficulties.

The official reported deficit for 2018-19 was £571m – a significant improvement on the previous year’s shortfall of £966m.

But this was largely thanks to a hugely beneficial accounting adjustment of £256m relating to two private finance initiative hospitals that were brought on to the government’s books following the collapse of Carillion. It also benefitted from more than £1bn of non-recurrent savings.

Meanwhile, the underlying deficit (stripping out one-off benefits) continues to deteriorate, with the report saying it has grown to £5bn from £4.3bn at the end of 2017-18.

There has also clearly been a decision taken at NHSI and NHS England to start talking loudly about the inadequacy of the capital funding envelope.

Last week, NHSE chair Lord David Prior called for a large uplift in capital spending. The latest NHSI report (which revealed a £500m overspend against the government-set limit last year) was far more adventurous in its assessment of the situation, saying: “The NHS faces ever-rising levels of backlog maintenance and is not investing sufficiently in new facilities.

“The UK has the fifth lowest rate of capital expenditure as a percentage of total health expenditure, out of 34 OECD countries with comparable data.”

Sensing a theme

Matthew Leahy and Mr R, as he is known in a recent Parliamentary and Health Service Ombudsman report, had a lot in common.

Both men were admitted to the former North Essex University Partnership Trust’s Linden Centre in Chelmsford. Both died – Matthew in 2012, after staff found him hanging in his room, while Mr R “killed himself” in 2008, according to a coroner’s report cited in the PHSO’s review. Both, according to the watchdog, suffered from similar shortcomings in their care, including failures to properly assess and manage risk, and failures to update care and treatment plans.

Just last week, Daily Insight lamented the long line of recent news stories involving mental health services which all seem similarly themed.

But, as the number of stories increase, it seems so too do the efforts to improve the state of mental health services. In what is thought to be a first for the watchdog, the PHSO has called for a national review into the “systemic failings” at NEPT, which has since merged with South Essex Partnership University Foundation Trust to form Essex University Partnership FT.

And its calls have been answered. NHS Improvement has agreed to commission a review, which will start once the Health and Safety Executive completes its ongoing investigation into the trust.