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

What would Albert Einstein, who said that “everything should be made as simple as possible, but no simpler” have made of the current debate around NHS finance, one wonders?

Earlier this month we revealed NHS England is considering a substantial return to a payment by results financial model for elective care in 2023-24, which in its fullest version would see trusts being paid purely per unit of activity.  


But NHS Providers’ interim chief executive Saffron Cordery told HSJ this week that this would “feel like a retrograde step” that would cut across the new integrated care system agenda.

Ms Cordery, speaking to HSJ ahead of NHS Providers’ annual conference in Liverpool this week, said she understood that PbR was an “enticing” option for system leaders because it’s a lever which in the past has been used to incentivise activity and it’s relatively simple.

But she argued: “I’m not sure that it fits with the ethos of system working, or that it will create what we need to create. It doesn’t solve the fundamental problem which is about flow and workforce availability. [PbR] won’t magic up new staff.”

HSJ wonders if using PbR to fund trusts for elective activity would pass Einstein’s great simplicity test or whether a more sophisticated model is required? 

A bridge to somewhere?

Forty years on from the opening of what was then the world’s longest suspension bridge, another grandiose project is hoping to connect both sides of the Humber.

Two trusts, Northern Lincolnshire and Goole on the south bank and Hull University Teaching Hospitals on the north, are pressing ahead with plans to merge their leadership teams and create a “group” with a combined turnover of £1.3bn.

Hull is a major tertiary centre while NLAG runs three district general hospitals. Both have been working closely together for more than a decade, in recent years pushing to rationalise services, share staff and submit joint capital bids.

The trusts already share a joint chair, Sean Lyons, who has stressed that the move is “not a merger and it is not a cost-saving exercise”.

Although the two trusts will appoint a joint chief executive and then a shared executive team, they will retain their individual identities and boards will continue to make decisions where appropriate. These safeguards are perhaps most important at NLAG, where consultants are concerned that the smaller of the two partners could see services on the south bank run down.

When it was announced, the bridge was dubbed a ‘bridge to nowhere’ by its critics. Hull and NLAG will be hoping to avoid that tag.

Also on today

The Primer this week turns its eye to coverage of the impending nurses’ strike and waiting list prioritisation, and in our new monthly expert briefing, patient leadership champion David Gilbert picks out the most significant developments in a field of increasing relevance to the NHS.