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

Counting out the cash

The NHS has known that extra money is coming for more than six months, but local leaders will today start realising the benefits of that £20.5bn boost.

Draft funding allocations for the five years from 2019-20 have now been issued by NHS England, with the new money being dished out according to a new distribution formula.

As trailed before Christmas, the formulas have been subject to new adjustments which effectively give more weight to deprivation, as well as mental health and community care needs.

The changes appear to benefit areas with more extreme levels of deprivation (as indicated by their mortality rates), such as Bradford and Blackpool, but also shift the share of funding to affluent areas such as West and Central London.

Despite benefitting from the new formula, the wealthy London boroughs will actually get much smaller cash growth than the rest of the country, because they were already well ahead of their “target share”. In other words, they currently receive far more than they would do if the new weightings were applied in full, and not eased in gradually.

Meanwhile, HSJ has also revealed that the cumulative funding pot over the next five years will now be £2bn less in real terms than the government previously promised.

Planning documents published by NHS England yesterday state that its budget will increase by 3.1 per cent in real terms in the second year of the period, as opposed to the 3.6 per cent that was proposed in the government’s high profile announcement last summer.

This will result in cumulative real terms spending over the five years being around £2bn lower than previously envisaged. In 2018-19 prices, cumulative spending will be around £632bn over the five years, rather than £634bn.

The phasing appears to have been tweaked after negotiations around inflation, which is now expected to be higher than forecast last summer. The government has apparently agreed to cover the inflation pressures, meaning the NHS will in fact get more in cash terms, but in exchange has backloaded the previously frontloaded real terms increase.

Given that the government and NHS England have always talked about the settlement in real terms, you might have expected any additional inflation pressures to be automatically covered. But with government budgets as tight as they are, and Brexit nearing ever closer, the Treasury was always going to drive a hard bargain.

Eight patients

Six months ago, the Dudley Group Foundation Trust commissioned a review into deaths within its accident and emergency department after receiving a safety warning from the Care Quality Commission.

The review, which has now been published, looked into 229 deaths over 2016-17 and 2017-18, and said it found eight patients whose care it had concerns about. That isn’t to say these deaths were avoidable, but that the care these patients had in A&E gave some cause for concern.

Overall, the review found more than 90 per cent of the cases in each of the two years examined were unavoidable.

It’s worth bearing in mind that, considering the type of patients presenting to A&E, it would not be surprising for a majority of deaths to be deemed unavoidable - but that doesn’t mean there weren’t elements of poor care. An interesting point made in the report is the need for the “system” around Dudley to review its end of life care within the community, trying to ensure people on this pathway who don’t need to be in A&E can avoid it.

The trust has had a tough couple of months with a series of CQC warnings and an “inadequate” rating for its A&E, so the review’s findings, at least for the most part, are likely to be welcomed.