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

Gone cap in hand

With no commissioning “risk reserve” in place for 2018-19 – as in the previous two years – a significant deficit in the provider sector was always likely to cause a major headache for the Department of Health and Social Care.

Predictably, providers look set to report a deficit approaching £1bn, and with the department and NHS England seemingly unable to cover this off by holding back spending in other areas, they’ve had to go cap in hand to the Treasury.

Liz Truss, chief secretary to HMT, has approved a £600m transfer of reserve funding to the DHSC to help avoid an embarrassing budget breach, which is described as covering “unforeseen” cost pressures.

Of course some – including HSJ’s Following the Money column – foresaw several months ago that the department was heading for a problem this year.

Sally Gainsbury, senior policy analyst at the Nuffield Trust think tank, said: “It’s not clear if the Treasury would usually contemplate additional in-year funding to cover a provider-side deficit, but the DHSC will have been able to point to other one-off costs such as Brexit and generic drug prices which have added to its pressures for this year.

“But the bottom line is the department has been heading for a problem in the accounts which it looks like this is designed to fill.”

Lobby bar

The move of NHS England’s chief digital officer Juliet Bauer to digital GP company Livi, and her subsequent ill-advised column, prompted a flurry of discussion about the so-called revolving door between tech companies and the NHS.

One concern was the lack of clarity between what controls NHS England had in place to prevent Ms Bauer – and other NHS England senior managers moving to the private sector – getting straight into the ear on their former colleagues. Civil servants have clear rules on how to navigate these doors (albeit often poorly enforced), but NHS England’s rules were not transparent to all, to say the least.

NHS England has now provided some more clarity in response to the concerns raised by the Commons health and social care committee. When Ms Bauer moves to Livi in April, NHS England has said she will not be able to “lobby” government, including central bodies like NHS England, for six months.

Presumably, this applies to other recent NHS England departures to the private sector, although NHS England has not made this clear.

The letter is also silent on whether Ms Bauer, or anyone else off to work for a supplier keen to expand its NHS business, can lobby local NHS organisations. After all, it will be clinical commissioning groups and GP groups, rather than NHS England, signing contracts with digital GP companies, and Livi’s NHS contracts to date have been with GP federations.

This is not to say NHS England’s decisions have no significant impact on the NHS fortunes of these digital GP companies. The obvious example is Babylon’s GP at Hand, recently cleared by NHS England to expand into Birmingham. NHS England also decides who gets on the framework that CCGs are meant to use when purchasing online GP consultation services (Livi was added to the framework in June 2018).

The long-term plan also envisages universal access to GP online consultations within four years, which will grow the market for such companies.

NHS England’s letter states that while Ms Bauer was “generally involved” in debating digital aspects of the plan, she was not making any decisions about specific commitments (presumably, this was Simon Stevens’ job). Likewise, she was not involved in deciding which suppliers were added to online consultation framework, the letter said.