HSJ’s round-up of Friday’s must read stories and debate

The elaborate Parliamentary bequeath

Simon Stevens is never too shy for a moan about the regularity with which he is hauled before parliamentary committees, and whoever has the pleasure of his company over Christmas can look forward to the NHS England chief executive griping  about his schedule this week.

On Tuesday morning Mr Stevens contributed to the epic evidence sessions of the Lords standing committe on the “long-term sustainability of the NHS”; on Wednesday he faces the indignity of being grilled by the commoners of the communities and local government select committee, about social care.

The peers did well to get in first, because Mr Stevens had some good lines ready. Deploying a soundbite few NHS chief executive peers could hope to match, he said that instead of a “triple lock” for pensions, he suggested that a “new way of thinking would be a triple guarantee around income, housing and care”. It’s a neat comment to throw into the simmering debate about funding long-term care and intergenerational fairness in government tax and spend.

Mr Stevens was modest enough to acknowledge that such reform will “clearly be a matter for government and parliament”.

Less modestly, perhaps, he delivered a “right back at ya” to the Palace of Westminster when pressed by peers on the messy state of NHS structures and processes following the Health Act 2012.

The NHS has been “bequeathed an elaborate set of super-structures by parliament, for which we are grateful”, Mr Stevens declared – although as an amelioration tactic he said we should all “act as if the system makes sense and then it’s more likely to”.

Those less generous than Daily Insight might dig out a link to Simon Stevens’ July 2010 Financial Times piece, in which he argued that “while the risks are substantial” of the Lansley Liberating the NHS proposals, “there are grounds for optimism”, and that the plans “build on many of the past decade’s reforms”.

In fairness, Mr Stevens concluded in the 2010 piece: “There is a third possibility, too, that nothing much happens at all, with patient choice a damp squib, GP commissioners fiddling at the margins, and hospitals unchanged. In my view that would pose the biggest risk. Deferring tough decisions now would leave the NHS facing a much bigger crisis in a few years’ time, when its budget crunch really begins to bite.” Which was quite perceptive. Now, back to working out how to defer those tough decisions.

£10m badly spent

Work to prepare for the now-abandoned merger of a flagship teaching hospital with its struggling neighbouring trust cost £10m, NHS Improvement has revealed.

A breakdown of spending by Nottingham University Hospitals Trust and Sherwood Forest Hospitals Foundation Trust on the project shows it included £6.6m on professional advice fees alone. Of this, HSJ understands £6.1m was paid for consultancy advice with £500,000 on legal fees.

This will presumably deal another blow to those trying to propagate provider merger as a big part of the solution to the NHS’s troubles - and in turn to hopes riding on these as a means of cost saving. Nottingham and Sherwood said it was operational pressure which led to them giving up, though there are those who think there were other reasons.

But the real beauty of this story is how the costs were dealt with: they have not been laid at the door of Nottingham or Sherwood (an admission at the centre that the local trusts were given little choice?). But nor has the Department of Health, yet, put its hand in its pocket. Instead, the joy and magic of the current provider financial regime means it can be dealt with via a simple paper control total adjustment of £10m in Sherwood’s favour. Unfortunately, those professional advisers have been – or will be – paid by someone, so the bucks (10 million of them) will stop somewhere.