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

The pandemic might not be over in hospitals but the financial security banket offered by the government to health and care systems during the crisis is at last coming to an end.

For the last two years, local NHS organisations have effectively seen all their spending covered by the government under temporary covid measures.

But it’s back to business as usual in April, when systems will be expected to deliver services from within funding envelopes set at the start of the year.

Some integrated care systems went into the pandemic with deficits of more than £100m, and will likely struggle to reach a balanced position.

However, it is unclear what the consequences will be for an ICS that fails to meet what is described as a “new joint legal duty”.

The financial envelopes for next year will be derived from pre-covid budgets, but also take into account what systems have actually been spending in 2021-22, as well as incorporating a “fair share” adjustment.

Continuity announcement

An inquiry into care failings at Shrewsbury and Telford Hospitals Trust has criticised a policy “at the heart” of NHS England’s efforts to improve maternity care, HSJ understands.

The Ockenden report into major care failings at Shrewsbury and Telford Hospital Trust included 15 “immediate actions” for all maternity services in England, which government has accepted and said it would begin implementation.

But one of these relates to the “continuity of carer” model, which NHS England has championed since 2017, when it was described as “at the heart of” its national plans for improving maternity care and outcomes.

The model intends to give women “dedicated support” from the same midwifery team throughout their pregnancy but Ms Ockenden says its implementation has stretched staffing, and therefore harmed quality and safety overall, and appeared to question whether model worked.

Her report said it should be “suspended until all trusts demonstrate staffing meets safe minimum requirements on all shifts”. 

Also on today

In The Ward Round, Annabelle Collins takes a deep dive into the malaise at the heart of the latest NHS Staff Survey, and in news, Nick Kituno reports the survey’s findings that a smaller proportion of NHS staff from ethnic minority backgrounds believe they have been given equal opportunities for career progression than in the last four years.