HSJ’s round-up of the must read stories in the NHS

The official deficit picture

Official figures published by NHS Improvement show the provider sector forecasting a £873m year-end deficit, against the maximum “control total” of £580m.

As revealed by HSJ last week, NHSI confirmed that initial figures submitted by trusts had summed to a combined deficit of £973m for 2016-17, and that this was reduced by £100m following discussions between the regulator and trust boards.

The year to date deficit stands at £886m, which is £202m worse than planned.

NHS Improvement’s quarter three report said increased pressure on emergency services caused “one of the toughest winters on record”, and resulted in thousands of escalation beds being open each day and the loss of elective income due to cancelled operations.

Meanwhile, HSJ analysis shows which trusts are performing best, and worst, against their financial plans in 2016-17.

Some positive news is that two trusts have emerged from financial special measures: Croydon Health Services Trust, and Norfolk and Norwich University Hospitals FT.

Planning the end of CCGs

In the leader column this week, HSJ editor Alastair McLellan has said CCGs have the “privilege of being able to prepare for their own end and to determine its time and circumstances”.

He is not calling for clinical commissioning groups to be scrapped tomorrow, but points out: “NHS organisations have a limited lifespan, and their demise tends to be traumatic for those involved and wasteful of  time and money.” This needn’t be the case for CCGs.

“Instead CCGs should recognise that changes taking place across the NHS – most importantly new models of care and the organisational landscape that supports them – will require a shift in the way services are planned and funded. In turn this spells a certain end for CCGs as envisaged in the Health Act 2012.”

The good work of CCGs in many areas also has to be preserved, rather than “forgotten then painfully relearned” as was the case when primary care trusts were dismantled.

STP lead departs?

The departure of Birmingham City Council’s chief executive Mark Rogers – announced this week – provides the latest twist in the saga of the Birmingham and Solihull sustainability and transformation plan, the conduct of which has long been the most interesting thing about it.

Birmingham and Solihull STP was the first to be published after it was published on the council’s website, against NHS England’s advice last October.

Mr Rogers then criticised the “sort out the NHS first” approach to the process, which he attributed to Simon Stevens and Jim Mackey. A process that treated social care as an equal partner would have been preferable, he suggested.

This drew a withering response from Mr Stevens: “It would be naïve to think, and I know Mark is not naïve, that the process of bringing together partners across Birmingham and Solihull could by itself mean that the NHS was able to cover off all of the funding pressures facing Birmingham city council. That’s why they say in the STP, that Mark has chaired, that one of the things they regard as unfinished business is the national policy on social care funding. Well, the STP process was never designed to answer that particular question.”

No date for departure has been set for Mr Rogers.

We would assume that Mr Rogers departure leaves a vacancy at the top of the Birmingham and Solihull STP.

Weirdly, neither NHS England nor the council have been willing to confirm this.

When Mr Rogers was brought in, it was to ensure the STP had an external big hitter able to arbitrate between the large providers and strong leaders in the Birmingham health system.

Is an outsider is still needed, or are Birmingham’s NHS leaders now more closely aligned than in the past?