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

Hate the game

You will be hard pressed to find an NHS leader willing to express any outward enthusiasm for “control totals” and the cash incentives on offer for hitting them.

HSJ has previously revealed the hugely distortive impact of doling out additional incentive cash to organisations which are able to boost their financial performance, at the expense of those which can’t.

NHS Providers says the system also incentivises short term fixes instead of encouraging trusts to focus on genuine productivity savings.

Despite the criticism, NHS Improvement has now doubled the impact of the incentive scheme, with trusts that agree tougher “control totals” now getting £2 for every £1 of improvement, as opposed to the £1 for £1 on offer in 2017-18.

The policy was taking a predictable battering on the HSJ comment thread at the time of writing, with one reader saying: “Whilst we all understood why this started, its continuation (and ramping up) now acts as a regressive financial mechanism which locks some trusts into an underclass and others have more money than they know what to do with.”

Yet, if these are the rules of the game, then you can’t really blame trusts for acting in their own self interest when opportunity arises.

For example, Surrey and Borders Partnership Foundation Trust is among the trusts set to take advantage of the scheme, by completing a land sale earlier than originally planned.

This will boost its revenue performance by £7m and attract an incentive payment of £14m from NHSI.

Nice work if you can get it, and any trust in this position would probably do the same.

Low flow

While the flow of district nurses into the NHS can hardly be described as a steady stream, even the small trickle we currently have is better than nothing. 

But it has come to HSJ’s attention that there could be no new district nurses qualifying in the summer of 2021, if - as Health Education England is currently planning - funding for its one year specialist post-graduate course is cut.

The logic behind the education regulator’s decision is that the government is due to launch its apprenticeship route into district nursing in 2020-21.

But the apprenticeship is expected to be a two year part time course, meaning those nurses going down this route would qualify in 2022-23, leaving a whole year (2021) where there could be no district nurses qualifying at all.

This potentially skipped year will likely cause concern among NHS providers with district nurses on their payroll and could hit community services very hard. No doubt there will be a knock on effect for other sectors, particularly acute hospitals which rely on community services teams to get patients out of hospital.

But there is hope. The Department of Health and Social Care has said it is working with HEE on a solution and future funding for the one year course will be subject to next year’s spending review.