Daily Insight: Please Simon, we want some more

The commissioner/provider split

Providers have got the begging bowl out ahead of winter, as is the custom, but instead of waving it at the Department of Health and the Treasury, they’ve stuck it under Simon Stevens’ nose.

NHS England appeared unamused. The national commissioning body issued a statement saying there was “no extra unallocated national funding”. Trusts needing extra capacity over winter would need to find local savings or “defer other planned in year national trust investment”, it said.

A senior trust source familiar with the national discussions, which have been going on over the summer, was optimistic that system level winter plans, including any extra funding allocation, would be finalised this week or next.

The winter funding issue has been bubbling away ever since the March budget when councils were allocated an extra £2bn of social care funding over the next three years – one of the primary aims of which was to help address delayed discharges.

While NHS England announced that between 2,000 to 3,000 beds could be freed up by addressing delayed discharges (if the funding was used optimally), providers raised concerns that this was not realistic because councils were using the cash to plug other holes in long underfunded social care services.

So where from here? The reality is that winter will be a mighty challenge regardless of whether more funding is made available – and trusts may still not be able to find the staff to cope with the demand.

But the politics are intriguing, with NHS Improvement and NHS Providers in one corner and NHS England in the other. Jeremy Hunt may view such a domestic as beneath him, but providers will certainly point back to this debate if the system starts creaking this winter and extra support hasn’t been found.

Battle against fraud in disarray

NHS’ counter fraud services are in some disarray, with NHS Protect becoming the NHS Counter Fraud Authority at some point this year (it was supposed to be July).

The name change belies an overall fall in budget and the ignoring of a key recommendation from the City of London Police, whose report into NHS counter fraud services HSJ unearthed this week.

NHS Protect investigates larger scale cases but local counter fraud services are responsible for everything else.

While acknowledging some good practice, the police report lamented the patchiness of local counter fraud provision.

The fact that 20 per cent of trusts are responsible for 50 per cent of fraud reports is not likely to be because this group is particularly corrupt – as the report noted, the patchiness will be to blame.

Some big firms provide local counter fraud services and organising potentially criminal investigations is often outside of their comfort zone.

The police recommended NHS Protect more directly managing local counter fraud services but this is not what is happening.

In an era of centralisation, counter fraud appears to be an exception.

The report also warned against changing the counter fraud training centre in Coventry but this has now been wound down.

NHS Protect is working on other problems the report identified, including a substandard IT system.

Others are unresolved, not least sometimes an obstructive attitude from some providers and no system for checking whether investigations will have major repercussions for services. An example of the latter was the arrest of a gang of corrupt hospital specialists resulting in the collapse of that service across the region.