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

A very wise decision, minister

In the run up to the NHS long-term plan, the realists in primary care had been steeling themselves to get pretty much sweet FA in terms of major investment in the next couple of years.

Expectation management was the name of the game, with most of the cash due in 2019 and 2020 thought likely to be soaked up by the acute sector sponge, which has been dried to a bone in recent times. Politicians will want to see progress on hospital targets ahead of a general election, surely, while mental health and cancer are at the front of the queue for improvement.

Step forward Matt Hancock, with a zest for “prevention” over “cure”, a professed zeal for “incremental reform”, and a declaration – in an extensive interview with HSJ – that the shift in resource from acute care to primary and community can’t wait and must begin next year.

That is a familiar aspiration for many HSJ readers, as comments under the story made clear.

One was quick to note the potential knock-on consequences for the acute sector, adopting the part of Sir Humphrey: “Of course minister, a very wise decision if I may say so. Now, which hospitals shall we close to pay for it?”

Mr Hancock said the overall growth for the NHS should mean there is enough headroom to keep meeting hospital demand while its share of the whole pie shrinks (mental health has also been promised a growing slice). That’s open to debate, but it seems unlikely unless expectations of performance and quality improvement on acutes are strictly limited.

Practically, spending fast enough in primary and community care in a way that gets value, while keeping pace with uncontrolled acute costs, has proved difficult in some years. Getting that traction in time for 2019-20 will require pretty rapid movement now, too.

In the same interview, Mr Hancock:

Storage wars

While speculation over a possible breakthrough in the government’s Brexit negotiations approaches fever pitch, national chiefs continue to prepare for a no-deal scenario.

NHS trusts are now being roped into those preparations and look likely to be given a larger role to play as 29 March draws closer.

Trusts may be asked to stockpile certain types of equipment, such as emergency treatment products, according to the Department of Health and Social Care’s head of supply resilience David Wathey.

Mr Wathey’s words caveat the official government position that trusts should not stockpile medicinal supplies, over concerns this could destabilise supply chains.

If the DHSC advises trusts to stock up on certain types of equipment, local chiefs will have to overcome potential headaches, such as a lack of storage space and extra costs.

Meanwhile, procurement teams across the NHS are busy assessing the implications of a no-deal Brexit on their trust’s supply chain. Trusts were told to submit assessments by the end of November, but HSJ understands many are likely to miss this deadline due to the sheer size of the work involved.