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

NHS no-deal dream team

Brexit continues to suck the life out of everything in its wake like a supersized Death Star.

The latest casualties are roughly 200 NHS England and Improvement staff, including NHS England director of acute care Keith Willett, who have been recruited to a team preparing the NHS for a no-deal Brexit.

Professor Willett will head the team from across NHSE and NHS Improvement’s national and regional staff, alongside NHSE’s national operations director Matthew Swindells.

The move comes at a critical time for Professor Willett’s core policy area. The NHS clinical review of standards, which is due to publish recommendations in the spring, is considering changing the four hour target.

During peace time, such a review would be occupying a considerably higher profile (although its brushing under the Brexit carpet may well be appreciated by NHS England medical director Stephen Powis, who is leading the review).

Professor Willett being seconded at such a time is yet another example of the staggering resource burden Brexit is placing on the NHS. 

Show me the method

The government’s new funding settlement has offered a welcome shift away from short term gains and unrealistic expectations when it comes to NHS finances.

It was encouraging, for example, to hear national leaders issue warnings about backloaded savings plans, and confirming that control total targets would be rebased to 2017-18 outturns.

The trust specific control totals have now been issued to trust leaders, who have been working through the detailed assumptions. Several finance directors told HSJ they are cautiously encouraged by the numbers, as well as the new measures that come with them.

For example, trusts will no longer be able to use land sales to meet their control totals, which up to this year has been a controversial accounting measure that’s had a disturbingly distortive effect on the sector.

HSJ has previously highlighted several examples of trusts meeting or exceeding their financial targets by completing large land sales, which has then triggered significant incentive payments (often going to already wealthy trusts).

The change has been welcomed by trust leaders.

But regarding the control totals, there’s a concern about the lack of transparency in the method used to rebase them.

NHS Providers says big non-recurrent items in 2017-18 have been discounted when setting the targets, which seems sensible.

But they believe smaller non-recurrent items have been ignored, which could create a problem for trusts that delivered lots of small one -off savings. HSJ has asked NHSI to clarify, but has so far had no explanation.