The must read stories and debate in the NHS


The DH debt mountain

The word ‘fantasy’ often crops up in discussions about STPs’ financial plans, even before we remember that dozens of NHS trusts will have to repay more than £2bn of bailout loans drawn down from the Department of Health.

Analysis by HSJ has revealed which STPs will face the largest mountain of debt.

It seems unlikely that organisations such as North Cumbria University Hospitals Foundation Trust, or Medway FT, will ever be able to repay their revenue loans.

These two trusts already have debts amounting to more than 30 per cent of their annual income, which are likely to keep on growing for several years until they move out of budget deficit.

There are many more trusts with smaller debts, which in all likelihood are just as unaffordable.

The STP process is designed to encourage closer collaboration between local providers, as well as commissioners, with the long term aim of moving towards a shared financial performance target.

So tough luck, it seems, to the apparently high-performing community and mental health trusts which have a debt-laden acute provider next door.

In reality, many of these debts are likely to be written off by the DH, but this is unlikely to happen quickly, so trusts have STPs will still have to budget for repayments in the short to medium term.

The trainee nurse cliff edge

New figures from UCAS today show an alarming 23 per cent drop in the number of applications to study nursing at English universities in the wake of the government’s changes to the bursary scheme.

However, much of the reporting of this has lacked the vital context around the fall in numbers and the fact it may not in truth herald a catastrophe.

Across the UK, UCAS told HSJ the number of applications fell from 56,080 in 2016 to 45,090 so far this year. For England only the number of applications fell from 43,800 to 33,810.

Why has almost all of the drop happened in England? Changes to bursaries only affect England, as does the advent of the “nursing associate” role.

But UCAS also made clear there were still thousands more applications to study nursing than there are places – last year there were only 29,000 training places across the whole of the UK.

Dame Jessica Corner, chair of the Council of Deans of Health, said: “Our members report receiving a high number of good quality applications for most courses and they will continue to recruit through to the summer. Where courses have historically had a large number of applicants, fewer applicants might well not affect eventual student numbers”.

Under the bursary scheme, which saw many students study for free, the dropout rates from nursing were extraordinarily high, reaching above 30 per cent at some universities.

It is possible that the high dropout rate was being driven by some students being attracted by the prospect of a free degree more than that of becoming a nurse. If so, it is possible that the drop in applications simply reflects less dedicated candidates being discouraged from the outset, rather than during their training.

Given there are many more applicants than places some of the hysteria around the news today from unions and the Labour party – particularly suggesting that it’s likely to exacerbate the nursing crisis – is unfounded.

The real threat to deepening the nursing crisis is Brexit, the failure to properly improve working conditions and retention of existing staff and undermining of professional nursing with new non-evidenced roles which could increase risk to patients.