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Total rejection

Leaders in the most “advanced” health economies have rejected national bodies’ terms for signing up to system-wide financial control totals.

Planning guidance published by NHS England and NHS Improvement in February said 10 “integrated care systems” would produce joint operational plans for the new financial year, including a combined financial target for the organisations within their area.

This is deemed a crucial step towards delivering integrated care and system planning within health economies.

The 10 areas were encouraged to adopt a “fully system-based approach” in which all their national sustainability funding would be tied to delivery of a system-wide control total for 2018-19. The guidance said all approved ICSs will be “required to operate under these fully developed system control total incentive structures by 2019-20”.

A second “interim approach” was also offered in which only a quarter of their sustainability funding allocation would depend on the system control total being met.

However, multiple sources across most of the ICS areas told HSJ they had not accepted either of the options because the financial risk outweighs the benefits. They said NHSE and NHSI are looking again at the proposals, after receiving alternative suggestions from multiple vanguards. They said the national bodies were open to finding a different solution and described the discussions as positive.

Kent’s coffers

Commissioners have been left with a £15m bill after losing a dispute with their local acute trust over procedures they said had been costed wrongly.

The four east Kent clinical commissioning groups and East Kent Hospitals University Foundation Trust had gone to arbitration over a large amount of elective and emergency work the CCGs felt had been misreported and “upcoded”.

The dispute went to “expert determination” – where a dispute is resolved by an outside figure paid for by the trust and commissioners.

Trust board papers said the CCGs estimated work valued at as much as £30m-40m could be involved, though the trust felt the amounts involved were far less. Work done for the CCGs to the end of January was above the planned contract value but only by £7.7m, according to the trust’s financial report.

But the outcome means the CCGs will have to find £15m extra for work carried out by the trust in 2017-18 – and a similar amount this financial year and next. There has been no adverse effect on the trust’s finances – it is expecting to report a £30m deficit this year.