The must read stories in health from Tuesday

Deficit decreased by technicalities

A series of one-off accounting measures helped boost the reported performance of the NHS provider sector by around £900m last year, according to figures obtained by HSJ.

The “technical adjustments” taken by trusts included revaluing some NHS property, extending the expected lifespan of some sites, and taking a more optimistic view of debt recovery and potential liabilities.

The measures, along with separate actions to defer £320m of capital expenditure, helped limit the provider sector deficit to £2.45bn in 2015-16.

NHS Improvement released details of the measures following a freedom of information request by us.

The actions, coupled with the deferral of capital spending, boosted the provider deficit by around £1.2bn. Assuming they were all one-off measures, this would suggest an underlying deficit of around £3.7bn. But some of the measures may have delivered recurrent savings.

The measures have mixed response from finance professionals and HSJ readers.

Paul Briddock, director of policy at the Healthcare Financial Management Association said they “push the boundaries” of acceptable public accounting but are legitimate.

However, readers commenting on the story were less forgiving. One said the technical adjustments were “unprecedented in public sector accounting”, while another asked if there had been “a technical transfer of funding from the smoke budget to the mirrors budget”.

Specialised treatment tussle

NHS England has announced the 18 new treatments it has selected to receive funding as part of its annual prioritisation round.

However, the national commissioner walked headlong into a row with a national charity by claiming a judicial review on HIV prevention stopped it from immediately rolling out the new services.

Earlier in the year NHS England said it could not consider funding pre-exposure prophylaxis (PREP) – which involves HIV negative people taking an antiretroviral drug to avoid getting HIV – because it claimed it did not have the legal power to commission it.

The national body said local authorities were the responsible commissioner for HIV prevention, and claimed that considering PREP in its prioritisation round would leave it open to legal challenge from advocates of other treatments that could end up being “displaced”.

More cynical onlookers think the move was an attempt by NHS England to shunt the cost of expensive drugs onto local government, and the National AIDS Trust promptly lodged a judicial review to challenge the decision.

How is this connected to NHS England’s announcement about the 18 new treatments? Well, NHS England said it couldn’t guarantee the new services will be funded until the outcome of the judicial review is known because it might be forced to re-run the prioritisation process.

NHS England didn’t hold back in its statement. Jonathan Fielden, director for specialised commissioning, said the organisation was “frustrated” by the delay caused by the judicial review, which was “preventing us confirming the new opportunities for so many”.

However the NAT argued the delays were “of the NHS’s own making” and said it was “incredibly important” it could challenge NHS England “to ensure accountability…and fair and equal access to treatments”.

Will NHS England have to repeat the prioritisation process with PREP included? The outcome of the judicial review is expected shortly, so we shouldn’t have to wait too long to find out.

Patients and NHS leaders join judging panel

CQC chief executive David Behan and Department of Health finance director David Williams are the latest leading figures to be named as judges for the 2016 HSJ Awards.

They will be joined by CQC chief inspector of general practice Professor Steve Field and NHS England director of commissioning strategy Ian Dodge.

All this year’s HSJ Awards categories will also have a patient representative on the judging panel. Among the latest judges to join include Kidney Alliance director Fiona Loud and Our Diabetes patient leader David Cragg.