The must read stories and talking points in health policy

Impossibly good news

As HSJ foretold last week, the first official performance report for the NHS provider sector has suggested that trusts are broadly on track with their financial plans for 2016-17.

The overall NHS provider sector has reported a deficit of £461m for the first three months of the financial year, which was £5m better than planned.

But if this looks impossibly good – given the £930m deficit at the same point last year – that’s because it includes about £450m of one-off sustainability funding. Without this, the year to date position would be a deficit of £911m.

And even then there are some heavy caveats, with experts warning that problems are likely to surface later in the year due to the sustainability fund incentives.

Frustratingly, NHS Improvement only published a supplementary report on Thursday, along with a press release hailing the good news. The main report should appear on Friday, including the trust by trust performance.

Though not completely clear, the smaller report seems to suggest that the current year-end forecast for the sector is £644m, which would be £64m worse than the planned £580m. And don’t forget, this includes the entire £1.8bn sustainability fund. It says further action will be taken to avoid this.

Interestingly, there is no mention of the previously stated requirement to reduce the deficit to £250m.

The planning plan

Summer is over, and a painfully ambitious two year, whole system, early planning round is here.

Letters sent to sustainability and transformation plan leaders in recent days confirm that operational plans and contracts for the 24 months from April 2017 will be expected to be pinned down by the end of December.

That may come as something of an unwelcome shock to those who are still spending their time rowing over 2015-16 activity and contracts. The timetable is well meant – the aim being to get planning and petty disputes out the way in order to get on with implementing the change outlined in STPs.

The recent updates to the system give a few signals on the context, too, ahead of planning guidance due on 20 September.

These include that capital will be severely constrained, as will IT funding, in the next few years. System control totals will be on the table, but will be strictly tempered with organisational responsibilities. There will be no windfall of transformation funding, because much of the national pot still needs to go into plugging acute trust deficits.

Planning rules from 2015-16, including the central control of CCG’s mandatory non-recurrent budgets, will mostly be maintained.

A number of difficult questions remain outstanding: will providers be bound in to STP commitments on funding, activity and workforce – and if so how? How can contracts be settled if the size of 2016-17 deficits (and therefore subsequent control total and sustainability fund requirements) are not known? Is the implication that there is a big shift to block contracting, and why should providers agree to this? How much transformation funding will be available, and who will control it?

All will become clear soon, no doubt.

New concerns at Stafford

You may have been forgiven for thinking that the Stafford hospital problem had been fixed. Sadly the hospital (renamed County Hospital), infamous for the care scandal and subsequent public inquiry that followed, is back in the headlines.

University Hospitals of North Midlands Trust, which took over the former Mid Staffordshire FT, has announced a temporary suspension of services for children at the hopsital’s A&E because of fears the department is not safe.

In particular the trust is worried that a shortage of staff trained in specialist skills for paediatrics, including life support resuscitation and anaesthetics, means it cannot safely treat children. The department sees an average of 30 children a day.

The concerns have been raised by a draft report produced by the West Midlands Quality Review Service.

The situation has frighteningly similar echoes to earlier reports at Mid Staffs. In fact, 10 years ago in August 2006 a peer review of services for critically ill children highlighted “immediate risks” to children because of a lack of staff trained in paediatric skills including life support.

The difference between 2006 and 2016 is that instead of this latest report being buried and never seeing the light of day, with unsafe services continuing unchanged, the trust now running the hospital has taken immediate, visible action to safeguard patients.