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

Winners and losers

After four opportunities to bid for capital funds during the last two years, more than £2.3bn has been allocated for more than 100 NHS projects.

But, as HSJ analysis reveals, the financial requirements from the health service go far beyond the amount allocated by the government.

Bid details obtained from the vast majority of NHS trusts show a combined capital request of nearly £9bn – close to the extra £10bn Sir Robert Naylor suggested should be channelled to sustainability and transformation partnerships in his 2017 review of the health service’s estate.

There have been some big winners but, inevitably, also some big losers. 

Estates teams in Shropshire, Cumbria, and Mid Essex may well be feeling flush after pulling in more than £600m between them. 

But Northamptonshire, Kent and Medway, Norfolk and Waveney, and East London STPs will no doubt be eyeing a place at the front of the queue for the next wave of capital settlements – details of which are expected in spring – after receiving little or no funding despite having hefty projects planned.

East London’s frustration at the process was evident when it spoke with HSJ. It would be interesting to know how many other STPs privately feel the same. 

While eyebrows were raised at the perceived lack of funding given to primary and community care, perhaps the most surprising of our findings was that a third of mental health trusts did not even submit bids to NHS England.

Given Care Quality Commission official Paul Lelliott’s recent comments on the state of mental health’s estate, it is hard to believe the sector didn’t ask because it didn’t need anything. 

Balancing act

Matt Hancock looks set to fly in a digital brain from his previous department, with HSJ revealing Matthew Gould is the favoured contender to lead NHSX.

Mr Gould may come from outside the NHS, but he is no lightweight. His resume straddles the upper echelons of the civil service and leans heavily towards technology and diplomacy. He has previously served as British ambassador to Israel and is currently the government’s director general of digital and media, working within DCMS, the health secretary’s old department.

But, as chief executive of NHSX, his role will be a unique one. NHSX is the very new joint venture between the Department of Health and Social Care and NHS England/Improvement that Mr Hancock hopes will tighten the centre’s focus on the digital transformation agenda. 

While the chief executive will (in theory) have sweeping powers over digital spending and strategy, enforcing standards and accelerating industry collaboration, it remains unclear how NHSX will function in practice. He will not directly employ any staff, who will effectively be seconded from NHSE and DHSC, and be accountable not only to Mr Hancock, but to NHS England.

This isn’t the first time Mr Gould has had to define a new role. He was the first ever DG for digital and media, and people who spoke to HSJ have had only good things to say about his likely appointment.

But leading NHSX will be a unique balancing act, which may prove a challenge for even the nimblest diplomat.