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

Property rights

The up and down financial performance of Royal Brompton and Harefield Foundation Trust perfectly illustrates the absurdity of the post 2015-16 financial regime.

Few trusts have done better out of the control total system than the west London specialist, which has received £66m of “sustainability funding” over the last two years against an original allocation of £13m.

The FT cashed in royally in 2017-18, when a large upward revaluation of an investment property helped it exceed its control total and trigger £40m of additional payments.

Yet, despite the trust now being set to miss its 2018-19 control total by £27m due to downward valuations on the same property (Chelsea Farmers Market), there will be relatively little downside.

It has already received £7m of its £11m sustainability funding allocation for the year, by staying on plan through the first nine months, so will only miss out on the remaining £4m.

This system – of huge reward and very little risk – has proved massively beneficial to trusts with scope to shake the balance sheet and report technical accounting gains. Those trusts tend to be in London and the major cities, where there is more high value estate to play with.

Reversal of fortune

Imperial College Healthcare Trust reported seven never events in 2018-19. All but one arose from invasive procedures.

Although trust board papers noted staff had fed back “issues in relation to teamwork and behaviours”, there appeared to be no single root cause for the string of events which should have never occurred. The trust is now in the process of rolling out a trust-wide action plan to address “a general concern about compliance with safety processes”.

Imperial had been making progress in reducing surgical never events, which have been a source of concern to the trust in recent years. It reported six in 2015-16 and four the year after. Investigations found similar issues across the incidents to do with leadership and teamwork, the application of a safer-surgery checklist, and trust policies “either not being followed or not complying with best practice”.

It seemed the trust’s efforts to deal with these concerns were bearing fruit – there was just one never event in 2017-18. There appear to be similarities between concerns then and issues being addressed now, and it’s not clear what has caused this reversal of fortune.