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Thin line between Right Care and rationing

NHS England has come to the defence of its Righ Care programme, following reports about commissioners using it to ration knee and hip surgery.

Using a subtle letter explaining how to use Right Care data for MSK pathways, the national commissioner told CCGs that hip and knee operations are quite cost effective and that investment should not be interpreted as “poor or good value without further investigation”.

However, NHS England’s attempt to gently nudge CCGs about rationing has been slightly ruined following a strongly worded email from regional officials.

When emailing the national team’s letter to CCGs, an area team warned they were aware that some CCGs are “rationing” joint replacement surgery using “arbitrary cutoffs” such as the Oxford pain scoring system and “restricting” surgery for smokers and obese people.

The email told commissioners to send a report on whether they had implemented these type of measures and warned if they intend to do so in the future they would need to get it agreed with their regional teams.

The Royal College of Surgeons said it welcomed the “very clear intervention” the Right Care team’s letter offered against “unfair” rationing of hip and knee operations and urged CCGs “to reverse any existing discriminatory policies”.

Cashflow slowed

Further cashflow headaches are on the horizon for many NHS trusts, due to unexplained delays to the bailout payments agreed by the Treasury.

HSJ has learned of further uncertainty over the timing of payments from the £1.8bn sustainability and transformation fund, which could leave more hospitals struggling to pay suppliers and relying on alternative loan support from the Department of Health.

Allocations from the STF, which was introduced to try and bring the provider sector out of deficit this financial year, are paid in four instalments to trusts that meet their financial and access targets.

Trusts were originally told that all four STF payments, if earned, would be made before the end of March 2017.

However, HSJ has learned that the payment relating to the fourth quarter of 2016-17 will not be made until the next financial year, while the third quarter payment is not guaranteed to come before the end of the month either.

Many acute trusts are in financial deficit and have reported cashflow problems in recent months, which in some cases has led to external suppliers refusing to provide goods or services.

There is significant frustration about the STF delays, the reasons for which have not been explained.