HSJ’s must read stories and talking points from Wednesday

Doctors’ warning

On Wednesday HSJ revealed that babies might be “dying unnecessarily” because of a flawed system for funding specialist units.

HSJ obtained a letter written by consultants at specialist units in London, warning that women and babies have been subject to “avoidable harm” because of the funding system for fetal medicine.

Fetal medicine was supposed to be commissioned nationally by NHS England as a specialised service with its own budget. However, in 2014 NHS England revealed that the money for the service was actually tied up in the maternity tariff – specialist units were expected to bill district general hospitals for any referrals they received.

The problem with this is because of the highly specialised nature of fetal medicine services, the cost of a referral frequently far outweighs the money which DGHs get through the tariff.

The London doctors argue this has created a perverse incentive for local units to “hold on” to patients when complications arise.

It has also resulted in tertiary centres haemorrhaging funds because when hospitals are “doing the right thing” and referring patients, only 10 per cent of bills are being paid.

The letter contains eight anonymised cases where patients have been “mismanaged” – sometimes with devastating results.

NHS England has said it is doing work to see whether it could “unbundle” the funding for fetal medicine tariff, with a view to potentially providing more appropriate reimbursement for services in 2018-19.

But fetal medicine doctors who are concerned about their financial sustainability – and most importantly the care of their patients – might question whether they can wait that long.

The next CCG merger?

In Tuesday’s Daily Insight, we revealed that moves were happening in Birmingham towards a full merger of three CCGs in the city and Solihull, or at least a major step in that direction.

HSJ published more details on Wednesday: Birmingham South Central, Birmingham CrossCity, and Solihull CCGs are understood to have met this week to discuss options to establish a “single commissioning voice”. Further discussions are expected to take place in the coming days to agree a proposal that can be put before the groups’ governing bodies

If a merger was agreed, the new organisation would be the largest CCG in England, covering the whole of the Birmingham and Solihull STP and its 1.2 million population.

A letter sent to local GPs last week said CCG leaders agreed on the need to create “one single commissioning function across Birmingham and Solihull”, although it was ambiguous about the form this would take.

A full merger is known to be under consideration but the groups have also discussed keeping three statutory bodies under a single management team.

Land up for grabs

NHS trusts in England sold land worth more than £250m to developers, housing associations and private individuals last year. Data released by the Health and Social Care Information Centre shows land declared surplus was also sold to charities and local authorities in 2015-16.

Nearly a fifth of the £250m total came from one sale in east London – Barts Health Trust sold 1.6 hectares of land at the London Chest Hospital to a housing association for £49.6m.

HSCIC also calculated that there were 545.7 hectares of land declared surplus by trusts with a “declared market value” of £334m.

As HSJ reported in February, a review of how the NHS can get better value from the land it owns in London is currently being led by UCLH chief executive Sir Robert Naylor. His initial report is due out later this year.