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

Boris and the Brexit bonanza

If there is one message to draw from the Conservative party conference in Manchester this year, it is the insistence the UK will leave the EU by 31 October “come what may”.

If you chose two messages to take away, the second would be that the Conservative Party is “the party of the NHS”.

“The NHS is holy to the people of this country,” Boris Johnson said in his conference-closing speech on Wednesday. The sanctity stems from “the simple beauty of its principle” that when one is ill, “the whole country figuratively gathers at your bedside and does everything it can to make you well again”.

“Everybody pays to ensure that you have the best doctors, and the best nurses, and the most effective treatments known to medical science.” After 70 years of the NHS, “we are slowly defeating the terrifying legions of disease” like cancer and heart disease, he said.

“But we have so much more to do,” he warned, before repeating the promise to build 40 new hospitals by 2030. He also repeated his promise to “fix the problem of social care and end the injustice that means people have to sell their home”.

Such largesse will not come cheap, but the prime minister had a simple solution: capitalism. “We are the party of the NHS precisely because we are the party of capitalism,” he enthused before explaining his vision for nation-unifying, productivity boosting investment in infrastructure and public services.

All that is to come, Mr Johnson promised, just as soon as he delivers Brexit.

Arguably any signficant distinction between trusts and foundation trusts – if there ever was one – disappeared about five years ago, as many of the latter tipped into major quality and financial failings. Regulators began treating them the same way and FTs’ independent regulator, Monitor, was in theory merged into NHSI.

Yet behaviours – and in this case laws – lag, and FTs, which continue to have freedom to set non-executives’ pay locally, have generally set it higher than what the NHS is allowed to pay NEDs in NHS trusts (which is controlled by the Treasury).

Regulators have found it increasingly difficult to find enough NEDs – let alone good ones – for the tough gig of trying to get unglamorous trusts on the path to recovery; and it’s become harder to argue FT boards have generally earned their premium.

So now – after, as they make clear, lengthy wrangling with the Treasury – NHS England and Improvement have set a pay framework intended to apply across both trusts and FTs. It is presented as a leveling up: trust NED and chair pay will substantially increase to become fairer over the next few years.

But the regulators also want convergence – meaning FTs would have to hold down or even lower what they are dishing out. 

It comes in the same week FTs learn they will soon get capital envelopes which they are expected to comply with. On that announcement as this one, there’s currently no legal basis for controlling FTs’ NEDs pay.