Daily Insight: Innovation without remuneration

Innovations to improve urgent and emergency care should be possible without extra central cash, an NHS England director has said.

Sarah-Jane Marsh, national director for urgent and emergency care, had set out NHS’s plans to manage the coming winter.

She said there would be no new NHS money to come with the winter letter. But in an interview with HSJ, she said: “We just need to be careful that we don’t get into the place where [people think] ‘we can’t innovate or make change unless we have direct central funding streams’. That’s not how lots of the innovations that have worked come about.”

NHSE is due to outline details of a capital funding pot to be made available to “incentivise” organisations to over-achieve against the demands within the urgent and emergency care recovery plan.

NHSE also plans to accelerate the rollout of transfer of care hubs to speed up discharges, put more ambulances and hospital beds in place, and expand the use of acute respiratory hubs. Ms Marsh also said she wanted to address the “variation” in services such as same day emergency care.

Summer freeze

NHSE’s finance boss Julian Kelly is “frustrated as hell that people are not doing the basics” on productivity, said one integrated care system source speaking about NHSE’s recent clampdown on spending.

“If you are not doing the basics… particularly if you’re in deficit, you can expect the ceiling to fall in on you.”

The problem is well diagnosed – the NHS has far more staff than before covid, but is still struggling to treat more patients. Mr Kelly’s prescription is to bear down on trust expenditure like a tonne of bricks.

A missive from NHSE, sent to ICSs in deficit, instructs them to review all their staffing vacancies to “consider where the removal or freezing of posts is appropriate”.

It says trusts must provide a “full justification” for staffing increases during the pandemic, including clinical posts, and produce a plan to cut these posts where “value for money is not demonstrated”.

But HSJ has learned the financial pressures are so great that some areas which are not in deficit (yet) are also mulling “unpalatable measures” to balance the books.

Miriam Deakin, from NHS Providers, said some were facing “particularly difficult recruitment decisions” as they look to hold back spending.