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

A&E goes dark

NHS England’s decision to omit 14 trusts piloting the new accident and emergency standards from the publicly reported four-hour target performance during the trial has prompted fresh concerns about the controversial trial, as we revealed last week.

NHSE’s decision to excuse the trial trusts from their public four-hour reporting duties so as “not to contaminate the study design” rang alarm bells at both the Nuffield Trust and the King’s Fund, which questioned the analytical approach and the apparent lack of transparency.

Deputy director of research Sarah Scobie told HSJ: “There is no reason not to publish the four-hour target data from the trial sites that we can see.”

The move needs to be viewed within the context of the debate around the hugely controversial review, which has been shrouded in secrecy from the very beginning.

Much like the exclusion of the expert group representing senior A&E clinicians, the Royal College of Emergency Medicine, from the original review group, these latest developments appear to add weight to concerns the process is being carried out in a black box to avoid scrutiny and with a decision already made.

Sucker punch

In the bizarre and illogical world of NHS finance, an auditor’s judgement on a single and very specific point of accounting treatment can influence where tens of millions of precious cash ends up.

University Hospitals of Derby and Burton Foundation Trust was in line for a bumper £59m payment from the national “provider sustainability fund” at the end of 2018-19, as it expected to trigger bonus PSF money by significantly surpassing its financial target thanks to a major asset sale.

HSJ has written many column inches on the disparities created by the PSF (previously STF) system, and UHDB obviously thought they could take advantage of the rules – as others have done in previous years.

But the trust’s plans, which had surely first been agreed with NHS Improvement, were subject to a “late audit adjustment” which resulted in the “reversal of an accounting treatment used to record an asset sale”.

So, the £59m has ended up being distributed – again very late in the day – to around 135 other trusts instead.

The sucker punch for UHDB, is that rule changes from NHSI mean 2018-19 was the last year in which the proceeds of asset sales could be used to boost “control total” performance and trigger additional PSF.

Can you imagine explaining to the people of Derby and Burton why they are suddenly missing out on £59m that could have been spent on improving their services?