The must stories and talking points in health policy

Fun and games in NHS finance

While the NHS waits for its long term funding plan, provider trusts are left with no choice but to play the control total game.

On Thursday, HSJ published several stories showing the various ways providers have succeeded or failed to navigate the regime.

There are trusts rejecting control totals that require impossible savings, such as Portsmouth, and which will miss out on sustainability and transformation funding as a result.

Then others are accepting extremely tough targets that had previously been rejected in draft plans, like Kettering.

Meanwhile, Barts has revealed its missed last year’s control total by £60m, but has still been awarded most of its STF money after NHS Improvement agreed to relax its target.

And Barnet, Enfield and Haringey Mental Health Trust has managed to beat its control total and trigger a massive STF payment by selling land to the council.

Capita contract fallout

On Thursday, the National Audit Office published its report into NHS England’s handling of the £330m primary care support services contract handed to Capita in 2015.

Through the contract, NHS England planned to reduce its costs by 35 per cent, while Capita bid for the contract in the knowledge it would make a loss in the first two years.

The report is the cherry on top of what has been reported to be a woeful service delivery from the beginning.

As well as the real risk of “serious patient harm” identified by the NAO, a key learning will be the criticism levied at NHSE and Capita regarding the procurement of the contract.

The report makes clear that NHSE did not know enough about the service when tendering the contract nor did Capita know what it was letting itself in for.

This was the perfect recipe for subsequent service problems. One of the most striking revelations was that NHSE did not have the contractual levers to intervene when it was worried about Capita’s actions. According to the report, in May 2016 NHSE wrote to Capita expressing concerns about the widespread closure of support offices and asked the provider to reconsider its plans.

However, under the contract Capita did not require NHSE’s agreement, so continued to close offices – much to the service’s detriment.

There have been many examples of major procurements in the NHS going wrong – the Circle/Hinchingbrooke debacle being a key example. The NAO’s report on Capita will serve as a warning over the huge consequences of not getting procurement right.