The must read stories and talking points in health

End of the road for NHS financial plan

It now seems clear that the NHS trust sector will blow its Treasury-agreed financial deficit for 2016-17, and will start next year struggling to catch up with a quickly disappearing recovery plan.

Mid-year performance figures collected from providers by HSJ suggest the sector is forecasting a deficit of £850m come March 2017, against the Treasury target of £580m.

Discounting the £1.8bn sustainability and transformation fund, the forecast deficit is around £2.65bn, against HMT’s control total of £2.38bn.

NHS regulators have been stressing the importance of these Q2 numbers in recent weeks and the need to “give confidence” to the government that finances are being brought under control.

The official figures from NHS Improvement, due later this month, will be spun as far as possible to that effect, but the reality makes for pretty grim reading.

There is still a huge risk the Q2 position will deteriorate due to many trusts “back-loading” their savings plans for the year, and some of the incentives around the STF allocations.

This means the underlying deficit is likely to keep on growing through the second half of the year, rather than shrink.

Let’s also remember that the trust sector has been set a “stretch target” deficit of £250m for 2016-17, with the added goal of achieving run rate balance heading into next year.

This ambition seems dead in the water, and means many trusts will be required to deliver large additional efficiencies to catch up in 2017-18.

No proof in this pudding

STPs are already known as “sticky toffee puddings” among some NHS leaders, but a plan leaked to HSJ has been described as “motherhood and apple pie” due to its lack of detail.

The document for the Lancashire and south Cumbria STP says £160m is required over the next two financial years to deliver key changes to NHS services, but largely sets out high level intentions rather than detailed options or proposals.

A senior leader in the region told HSJ decisions around service or organisational mergers have not yet been taken, while another said: “There’s absolutely nothing in the STP. It’s all motherhood and apple pie.”

More NHS money for the lawyers

On Thursday, NHS England lost its appeal against the High Court ruling that it has the power to commission the preventative HIV drug PrEP.

NHS England had claimed it couldn’t consider funding PrEP – which involves HIV negative people taking an antiretroviral drug to avoid getting the condition – because it didn’t have the legal power to commission it.

The national commissioner instead argued that responsibility for preventative medicine for sexually transmitted diseases lay with local authorities.

Unfortunately for NHS England it failed to convince a court of its case for a second time – the Court of Appeal upheld the judgment which was made in May. This doesn’t mean that PrEP will now automatically become available on the NHS, but it does mean that NHS England’s clinical priorities advisory group has to give consideration to commissioning it.

The latest judgment is important for two reasons. First, and most obviously, if NHS England does end up commissioning the drug then it has the potential to significantly reduce HIV transmission.

However, the decision also has repercussions for other condition areas. If PrEP gets commissioned then NHS England will need to set aside £10m-20m a year to pay for it. This could result in other treatments which had been earmarked for commissioning by NHS England earlier in the year not being funded.

The judgment also contained some harsh words about the NHS architecture bequeathed by Andrew Lansley.

Lord Justice Longmore said it “sadly” appeared that “bureaucratic squabbles” about funding responsibility between different parts of the health and care system was “the inevitable consequence of the Lansley reforms”.

He waspishly added that it was perhaps not the best idea to go about resolving these squabbles “by spending taxpayer’s money to expensive solicitors and barristers”.

“It would be far more sensible to have an internal mechanism for sorting out such disputes,” he suggested.

This isn’t the first time NHS England has spent money in court (supposedly to protect its budget), lost and then spent more money appealing the decision.

Last month it was accused of an “abuse of public money” for seeking to appeal a High Court decision that it should prescribe a drug to a teenager with narcolepsy.

After this legal defeat, perhaps NHS England should reflect on the learned judge’s words?