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

Financial innovation

When policy people talk about Treasury reluctance to commit more money to the NHS, things like this are partly to blame.

King’s College Hospital Foundation Trust was working hard to staunch its deficit in 2017-18.

But booking £10m of income by selling your scanning equipment to a wholly-owned company, who pay for it with a loan you made them, is pretty arcane, even for King’s.

Managed service contracts are nothing new in the NHS, but when they involve a trust booking £10m in sales in one year, you wonder what else has gone on.

Former chair Ian Smith alluded to some issues that have yet to come to light at his last public board meeting.

King’s Facilities Management, the company, and its relationship with the trust came in for criticism from PwC in its report into what went wrong there.

The never-properly-disclosed problems the consultants found in the governance arrangements between the two entities are now, apparently, resolved.

But it’s not just King’s. HSJ reported last year on the existence of a (never disclosed) report into governance issues between Guy’s and St Thomas’ FT and its spun-out facilities management firm Essentia. The trust did admit there was a “clear potential conflict of interest” in having its head of estates also run Essentia.

GSTT chair Sir Hugh Taylor is now also chair of King’s. If/when a merger between the Shelford Group giants goes ahead, perhaps the rule will be run over any other financial innovations at Denmark Hill just as rigorously (and unaccountably).

Another false start?

This month, 300 medical examiners were supposed to start reviewing all hospital deaths in England and Wales, as part of a major effort to improve patient safety and reform the UK’s outdated death certification system.

Despite a decade of delays and false starts since legislation was originally passed in 2009, the newly designed system of examiners based in acute hospitals is now at least reality in a “handful” of locations.

New national medical examiner Alan Fletcher has signalled he expects all areas to have a medical examiner in place by 2020, with all deaths, including community and mental health patients, reviewed from 2021.

In a letter to NHS medical and nursing directors last week, Dr Fletcher accepted the communications about the new system had not been great, but he outlined his plans for regional medical examiners to help provide local hospital MEs a level of independence.

The pilot schemes show the ME system has great potential but the next 12 months will be crucial to ensure it delivers.