The must read stories and debate from Tuesday

Dire warnings from directors under pressure

Finance directors in the NHS are being put under pressure from NHS regulators to agree to overly optimistic financial assumptions and to agree to “fundamentally unsustainable” financial control totals for 2016-17, according to a leaked letter authored by the boss of the Chartered Institute for Public Finance and Accountancy.

The letter, sent to CIPFA members by chief executive Rob Whiteman, will come as no surprise to those trying to balance the NHS’s books and negotiate with NHS Improvement and NHS England over their planned savings targets for the current financial year.

The letter said concerns had been raised “by CIPFA members across the health sector regarding the external pressure which is being placed on them by health regulators. Among their number are members who have been involved in the transaction reviews over year-end 2015-16 and those who are struggling to sign up to control totals for 2016-17.”

It added: “CIPFA believes there is a fine line between an optimistic judgement and an incorrect assumption. Bringing in accountancy firms to comment on the assessments made suggests a level of distrust in the professional judgement of NHS finance directors.

“It looks likely that estimates of over-optimism will be used to make adjustments to the Department of Health accounts leaving the consolidated DH totals unsupported by those of the constituent entities and in need of similar adjustments in years to come.”

The letter follows HSJ reporting earlier this year that an NHS finance director wrote to MPs to warn that hospitals could come under pressure to “cook the books”.

HSJ readers wasted no time in adding their thoughts to the story, with one saying: “Sadly the control total bullying is already happening. Four Hospitals that I know now have to find an extra £25m savings in nine months to hit the control total. It won’t be achieved.”

Another said: “This will be a catastrophic year for the NHS. It’s been on the cards now for nearly a decade and how it’s got to this is beyond comprehension.”

Contract winners and losers

NHS England has announced which organisations have won contracts for stereotactic radiosurgery and radiotherapy services.

The national commissioner has overhauled the two specialist radiotherapy services, which use focused beams of radiation to treat brain tumours, to increase the throughput of patients going through the services.

NHS England hopes this will allow it to expand treatments (from 2,400 patients treated in 2014-15 to 6,200 patients 2018-19), while reducing variation and inequality and cutting per patient costs (the move will apparently release efficiency savings of 25 per cent).

Not everyone’s a winner though – East and North Hertfordshire Trust has had its service decommissioned, although it told HSJ it hoped it would be able to offset the loss of activity through increased referrals in other disease areas.

The overhaul involves centralisation (in seven areas neuroscience networks have been merged to get to the required population footprint). It will be interesting to see if this marks the start of a new chapter of NHS England specialised services being centralised.