Daily Insight: How to spend £200m

Who got what from the pot

NHS England has released details of how it spent the £200m fund for transforming the health service in 2015-16 – we published the full details on Thursday.

The data shows which vanguards received how much money, how much of their own funding they put in too, and how much was spent on centrally run programmes.

So we learn that primary and acute care systems are the best funded part of the vanguard, receiving over £5m per site on average – and they are the only part of the vanguard to more than match the transformation funding with their own resources.

Nearly two thirds of the total pot – £132.6m – went on vanguards. Around £34m was spent on the national support package for vanguards. Other central programmes which benefited from the transformation fund were Care.data, the success regime and diabetes prevention.

Head to hsj.co.uk for all the details, including which vanguard was the only one to receive next to no cash.

Commissioners need clarity

Staying on new care models, earlier this week HSJ reported how new EU competition regulations could pose a threat to vanguards’ plans.

Meanwhile, on Thursday we reported how the Public Contract Regulations 2015 have already scuppered attempts at health and social care integration in Somerset.

Somerset CCG wants the health and care providers on its patch to come together to form two “accountable joint ventures” in the east and west, with each joint venture holding an outcomes based budget to pay for their population’s care.

However, David Slack, the CCG’s managing director, revealed that Somerset County Council had decided against rolling its social care money into the new contracts because “the legal advice was that they could not participate in that”.

The council had been advised that it could not participate in the process because the CCG was intending to establish the contracts through a non-competitive “most capable provider” process, and the new regulations prevented it from going down this route.

The regulations become applicable to NHS organisations later this month but have applied to the rest of the public sector for a year. Mr Slack suggested the CCG had received advice from Monitor that after 18 April 2016 a most capable provider process would not be “available”.

NHS Improvement and NHS England are yet to confirm the exact meaning of the regulations, but they need to quickly as it is vital commissioners know what they can and cannot do.

Locum crisis in Lancs

In case you missed it, HSJ broke the story on Wednesday evening that Lancashire Teaching Hospitals FT will be downgrading its Chorley A&E department on Monday.

The unit will close overnight but it will run as an urgent care centre between 8am and 8pm. The trust’s A&E in Preston will remain open.

Chief executive Karen Partington told HSJ it had only half the middle grade doctors needed to staff its two A&Es, after locum doctors resigned from the trust to work at other North West hospitals which are paying over the cap for temporary staff.

Ms Partington told us: “We have a rota for 14 middle grade doctors to provide care in A&E across both sites. We currently have eight people in those posts.

“When the agency cap was introduced in November we held the line and a number of doctors did say they were going to stay and work, and work under the caps. We held the line because I felt it was the right thing to do.

“When the February cap came in, again we held the line but then we discovered that other [trusts] were not and not declaring it, or recruiting people under the cap with other benefits that were below the radar.”

When the trust tried to recruit new clinicians it received no CVs. Ms Partington put this down to then region being “under doctored” and the trust being “known as an organisation that held the line”. “The issue is not the cap, it’s about how it was applied. Trusts didn’t act collectively,” she said.