The must read stories and debate from Wednesday

Penny wise, pound foolish?

Choosing the right flu strain to tackle is not easy. Each year, before winter, GPs will be gearing up for flu season and buying their supply of vaccines. There are currently two main choices: quadrivalent or trivalent.

Of these, quadrivalent, is considerably more expensive for the NHS but does offer protection against an extra strain of flu that the other doesn’t. It’s a tough decision for GPs and trusts: do they take a gamble and order the cheaper vaccine which covers less strains, or do they buy the one which offers that extra little bit of cover?

For NHS England and local commissioners, it seems they thought it was better to go with what is kinder on the pocket – trivalent. At least according to the documents HSJ has found in which GPs were advised by both NHS England regional teams and their clinical commissioning groups not to buy quadrivalent until it had been deemed “cost effective”.

Fast forward to winter, where a high number of flu cases are of the strain which is covered by the quadrivalent and not trivalent vaccine. Some questions may be asked over whether NHS England’s advice was penny wise but pound foolish.

Another query may also be raised about whether NHS England and CCGs should really wade in on what is a clinical decision.

Pay bar raised

The pay threshold for very senior managers in the NHS is no longer tied to the prime minister’s salary and has been increased by more than £7,000.

The threshold has been raised by the Treasury from £142,500 – the prime minister’s annual wage – to £150,000, as part of a new senior pay transparency policy. Trusts will still need to seek permission for appointments and pay rises above this amount.

In June 2015, Jeremy Hunt set out rules for trusts about the appointment of new senior managers being paid more than £142,500, saying these must be approved by the Treasury.

Last year, HSJ revealed that the thresholds were largely ineffective at holding down pay with nine out of 10 requests to pay more being approved in 2016-17.