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

Market forces

It sounds like an almighty row could be brewing over the contentious “market forces factor”.

HSJ understands that an engagement document for the national payment tariff is set to introduce a long overdue update to the MFF, which is a mechanism within the tariff that takes account of cost variations in different geographies, and has not been updated for several years.

Critics have long complained that the MFF is overly favourable to larger teaching trusts in London, which provide specialised services, so any changes are likely to cause a stir among some influential people.

Meanwhile, following on from Simon Stevens calling out the “obsolete” service model for outpatients still widely used across the NHS, the engagement document is also expected to propose cutting payments made to hospitals for traditional consultant led outpatient appointments.

Questions remain

It’s never a good sign when a trust stops reporting its referral to treatment times, and when that trust is one of the largest in the country it’s even more worrying.

Barts Health Trust recently restarted submitting its data to the national collection after an absence of nearly four years.

While that return to the fold is to be applauded, serious questions remain over why the absence was so prolonged and whether patients came to harm as a result.

Uniting the data systems of three different hospitals (Barts Health Trust was formed in 2012) was never going to be easy – often a patient’s pathway can show as incomplete simply because they haven’t been taken off one of several records systems at the end of their treatment.

But it’s a serious matter when a trust doesn’t know the status of a patient’s treatment – it could indicate they have missed a vital follow-up, screening or procedure.

We don’t know yet how many patients came to harm, and how serious that harm was as a result of these data problems, but similar experiences at St George’s in south London and Portsmouth, where patients died, suggest it could be significant.

The difficulty the trust has had in even completing an investigation into what went wrong is also disquieting.