HSJ’s round-up of the must read stories from Thursday

Finance targets unrealistic?

When a financial target gets handed down from the Treasury, Department of Health, and NHS regulators, there’s a pretty good chance that within a few months it will get scrapped and replaced with something more realistic.

Earlier this week, chief regulator Jim Mackey admitted the earlier ambition for the provider sector to reach financial balance in 2016-17 would not be achieved.

And flipping back to 2015-16 (which seems far from over both financially and politically), analysis by HSJ today showed a further worsening of the position in the final months of that year.

NHS Improvement’s year-end finance report suggests a further deterioration of around £350m in the last three months of 2015-16, despite orders in January for “collective urgent action” to find further savings, including threatened “headcount reductions”.

HSJ identified the 10 trusts which fell the furthest between January and April, with North Bristol Trust reporting a staggering deterioration of more than £17m.

The trust pointed to the usual suspects: high levels of agency spending; problems with patient flow; and the inability to carry out operations as planned.

The upshot of all this was a reported year-end deficit of £2.45bn, even once the boost of capital-to-revenue transfers and other “technical measures” were accounted for, which is well short of the £1.8bn “target” declared earlier in the year. Which leaves the Department of Health in a pretty sticky position when it comes to balancing the overall group accounts and not busting the DEL.

STPs undemocratic?

Should the sustainability and transformation planning process be democratic? Or would too much democracy just slow things down?

Concerns over the STP process have been raised by a City and Hackney CCG leader, and have brought up some interesting questions over the best way to bring about rapid change. An STP brings together leaders from all corners of the health economy so surely a democratic approach to planning would be the best approach to take?

Maybe so, but not if democracy means unanimity: when you’re planning at scale getting everyone’s signature for controversial decisions will be difficult, and Simon Stevens has already indicated that STP leaders will be allowed the casting vote where there are disagreements between partners.

The objections from City and Hackney demonstrate how the need to actually make decisions is butting up against keeping everyone happy: leaders are not pleased at the prospect of being outvoted by other STP partners, and the threat to CCGs’ individual sovereignty posed by the process.

And what about the public? The need to move the STP process along quickly is clearly a challenge to the idea that there should be an “open” dialogue with the people who pay for and use the service.

HSJ readers have been debating whether STPs should be available made available for public view while they are being produced.

“The quicker the decision-making process, the less time there is for democratic influence”, one anonymous commenter suspects. “This is why these decisions are being bounced through quickly.”

Another adds: “I support the need to get on fast with proposals for big change so as to make the NHS viable, but someone is going to challenge this secrecy in fairly short order, because the underlying requirements for public involvement… have not gone away.”