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

Two-track approach

The financial “control totals” that were introduced for all NHS trusts a few years ago represented a blanket response to ballooning deficits.

But the new regime – outlined last week by NHS England and NHS Improvement – will take a two-track approach.

Those trusts which can make a surplus (before non-recurrent support funding) will be released from control totals and given the freedom to set their own financial plan.

Those that can’t will work to rebased control totals, and will gain access to the new “financial recovery fund”. The rebased targets do require additional efficiencies, but are far more realistic than the targets handed down since 2016.

Ominously, the regulators warn trusts will be held “more robustly to account” for meeting them, although it’s unclear how they will do that exactly.

All this was more or less expected, but an unexpected measure introduces new “transitional reward payments” to surplus trusts, worth 0.5 per cent of their income. For example, a provider with an annual income of £500m would receive £2.5m.

This appears to be a sop to trusts that have done very nicely out of the previous regime, whose leaders had complained of being a victim of their own success, by being excluded from receiving any incentive payments.

Double checking

NHS England’s national director for mental health Claire Murdoch has tightened up her trust’s recruitment checks, including requiring all staff who have been subject to action from a professional body to get director approval before being hired. She is considering asking all trusts to follow suit.

Her action was prompted by the revelation that her trust, Central and North West London Mental Health Foundation Trust, hired a senior matron called who was disciplined by the Nursing and Midwifery Council for falsifying the care records of Matthew Leahy – a young man who died at an Essex mental health unit.

Readers may recognise Mr Leahy’s name. There have been some high-profile reports revealing multiple failings in his care.

Ms Murdoch’s move shows some positive action on an issue which is perhaps not quite at the top of trust agendas – quality checking the history of the staff they employ.

Actions by professional bodies can be wider ranging, and may not indicate poor care from an individual. Many trusts believe that if the NMC or General Medical Council do not take away a clinician’s registration they are in effect still employable.

However, there can be instances where the disciplinary actions can be for very serious misdemeanours and so it is right that a trust looks into the details.

Although this could slow down recruitment processes, it is important patient safety is treated as a priority.