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

Ministers and national NHS leaders have been given plenty of stick over the last few years for giving providers impossible financial targets to hit.

There have been particular concerns over the sustainability of the acute providers in Liverpool, which both finished 2018-19 with large deficits and were this month merged together.

So, it’s encouraging to see Liverpool University Hospitals Foundation Trust given what look to be far more realistic efficiency requirements next year.

Despite being in deficit (which NHS England and NHS Improvement said would require “minimum” baseline efficiencies of 1.6 per cent), the trust has been set lower targets than this over the next few years, with substantial support from the “financial recovery fund”.

Steve Warburton, the chief executive, will be delighted that his public intervention earlier this year, in which he called for the unique difficulties facing the city’s acute hospitals to be recognised, appears to have made a difference.

Meanwhile, the Treasury has also guaranteed the trust will receive significant capital investment to complete the new Royal Liverpool Hospital, which was left part-built when Carillion, the contractor, collapsed.

So, the trust will avoid the need to make annual unitary payments for the next several decades, as would have been the case if its private finance initiative contract had remained in place.

To cap this off, the trust has assumed a “good” rating from the Care Quality Commission, following a favourable aggregation of the ratings for its two predecessor trusts.

All this good fortune is unlikely to be applauded from all corners of the NHS, however. As one reader sneered: “How many other ‘important’ organisations will now broadly ignore the requirement to break even in the planning cycle”.

Staff facing discrimination

Stamping out discrimination in the NHS is an often-declared priority among its leaders, but the picture on the frontline can confound good intentions.

The service is also, of course, bound up with its users — and in one striking example, a small mental health trust has found nearly half of its black and minority ethnic background staff say they’ve been abused, bullied or harassed by patients and visitors, in comparison to less than a third of their white colleagues. This had increased by almost 20 percentage points on the previous year.

Some NHS leaders have, admirably, been more outspoken about this kind of issue in recent months. A number of frank observations were made at an HSJ roundtable of chief executives earlier this year. Devon Partnership Trust chief executive Melanie Walker said there was “overt racism and homophobia” on her patch, while East Suffolk and North Essex Foundation Trust chief executive Nick Hulme spoke in direct terms about attitudes in north east Essex.

Dealing with it, it would seem, takes bold leadership but also sensitive judgement.

Lincolnshire — a difficult area for NHS recruitment at the best of times — says it has focused on increasing awareness and reporting, which may be behind the large increase.

If NHS leaders continue trying to grasp the service’s diversity problem, it will be vital they absorb the views of their minority staff and take meaningful action where appropriate. Without it, they may instil regressive attitudes and repel even more potential recruits from a desperately shrinking workforce.