HSJ’s round-up of Thursday’s must read stories

The last of their kind

Jim Mackey has already said that a very small part of NHS Improvement’s time is going to be spent assessing FT applications from non-FTs.

Quite understandable, given the far more serious performance and finance issues gripping every part of the provider sector at the moment.

Although they have been reluctant to discuss it, the board promised a “revised approach” to the work at the other end of the summer.

So well done to Birmingham and Sussex community trusts for getting authorised this week – but as the FT policy retreats even further into the background its worth reflecting on some of the problems it has had.

The recent travails at St George’s and Liverpool are well documented, what is less well articulated is the overall effect of the FT assessment process.

In many cases trusts had to cut costs to meet the threshold for FT, and this often meant cutting nurse numbers. This happened in hospitals up and down the country over the past five years. This was held up as a bad thing when the service lurched to prizing quality over everything else with Jeremy Hunt.

The FT process was considered less relevant than ever.

Now that the government wants to finesse things back towards thrift, could they make a comeback as a cash saving initiative?

They have never been less independent and the idea that FTs are freer to innovate than other trusts in a world run by STPs is a little unlikely.

Junior docs’ contract published

The government has published the final junior doctors’ contract ahead of it being imposed on junior doctors this August.

Alongside this, the Department of Health has published an equality impact assessment of the planned contract and extended pay protection for doctors working less than full-time or on maternity care.

This decision could well leave the government open to criticism from NHS trusts who have previously raised concerns over the costs of pay protection alongside implementing the contract’s increased seven day working and unsocial hours pay.

Publication of the contract details comes ahead of a 48 hour strike by junior doctors from 6 April and full walkouts including emergency care on 26 and 27 of April between 8am and 5pm.

On the same afternoon, the BMA followed through with its threat to take to judicial review the government’s planned imposition on the grounds that Mr Hunt had not considered the equality impact issues. That would now seem to be a pointless endeavour and of course the union’s own legal advice warned this could happen.

While Mr Hunt may consider the junior doctors’ dispute closed the publication of the final contract and reaction to it is likely to show that it remains one of the most problematic areas for the government.

Light years of progress

At NHS England’s board meeting on Thursday, Paul Baumann announced that the national commissioner had delivered a roughly £500m underspend in 2015-16. The surplus is NHS England’s contribution to the attempt to rescue the Department of Health’s bottom line, which is threatened by an unprecedented provider sector deficit.

However, the finance director cautioned against excessive optimism about the financial position of the commissioning sector. He warned that the underspend was accounted for by three “non-recurrent factors” – lower than expected continuing healthcare payments, lower central programme costs and rate rebates.

Mr Baumann has another reason to be cheerful though. He reported that NHS England’s specialised commissioning budget had gone from being the organisation’s “biggest problem” to a “small problem”. In the year to January it was overspent by just £8m – in Mr Baumann’s words, a “light years difference” from historic overspends.