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

Community services lose out

A well repeated mantra in HSJ of late has been the neglect of the NHS’s new Cinderella service. Following the Liverpool community services scandal, Carter report and abandoned forward view, the underfunding of community services has come in to sharp focus over the past few months.

It seems that once again Cinderella has failed to make it to the ball.

Publishing its consolidated accounts, NHS Improvement has given a breakdown of trust income for acute, mental health, community and ambulance services. It’s clearly been a tough financial year for all four services but the area which drew the shortest straw, at least in funding terms, was community services.

The figures showed a £300m decrease for these services during 2017-18 compared to 2016-17, despite an increase in funding for all three other areas.

NHS trusts do not run the totality of community services and there is around £3bn which is not included in these figures – ie on services run by private or social enterprises. As some readers have suggested, if commissioners spending decisions are taken as a trend, this may mean the funding cuts in the sector were even greater.

This is perhaps the fourth time HSJ has asked the question – will it really be possible to meet the Five Year Forward View’s expectations and move more care into the community while simultaneously reducing funding for the sector?

Pay deal

Last month, the government pledged to fully fund the first year of the Agenda for Change pay deal – but there were always going to be some grey areas likely to hit providers with extra costs.

In his last days in office, former health and social care secretary Jeremy Hunt offered assurance that funding was also being offered for thousands of AfC staff employed by NHS subsidiary companies, social enterprises, or outsourced services – as well as those directly employed by the NHS.

But further details of this “eligibility” have now emerged in a letter to trusts from NHS Improvement, which says the offer only covers those organisations which are “dynamically” using the AfC contract “in full for both existing and future staff”.

This means additional funding will not be provided for staff who have retained their AfC terms and conditions after transferring into non-NHS bodies, unless the body is still employing new staff on AfC.

The letter confirms that most subsidiaries and outsourced services will not meet these criteria.

This has riled NHS Providers, which believes ministers have gone back on their funding commitment, and left quite a few trusts with unfunded extra costs and difficult “control totals” to meet.

It also offered up an “I told you so moment” for the Unison union, which has been heavily critical of trusts looking to phase out AfC for non-clinical staff by transferring them into subsidiaries.

Head of health Sara Gorton said: “It’s good to see that where employers have recognised the value of sticking with Agenda for Change, they will get the additional funding they need.

“But for those health workers who have been cut adrift from Agenda for Change, the future for their pay is uncertain and we risk a widening and damaging gap between directly employed staff and those who work alongside in contractors and arms length companies.”