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

Thursday’s 2023 staff survey results were a mixed bag, with important improvements in some scores, but others showing morale still in the doldrums in the post-covid malaise – especially in integrated care boards.

Alarming signs on discrimination, too, and new figures putting a size on the NHS’s sexual harassment problem.

As Matthew Winn and Chris Graham say on our podcast this week, the value is in trusts drilling down into the fine detail for their teams. 

The results can also be an excellent barometer of organisational health and, as a barometer, HSJ focuses on what share of trusts’ staff recommend them as a place to work. 

You can find more detailed analysis by sector and region here.

But here’s the most improved trusts from 2022 to 2023 across all sectors:

most improved all

And here are the most deteriorated year-on-year across all sectors:

most down all

Taxman in reverse gear

The taxman has been dealt a bitter blow in the latest round of a lengthy court battle over the vexed issue of NHS car parking charges.

Plucky Northumbria Healthcare Foundation Trust has been leading the charge in a legal dispute revolving around whether trusts have to levy VAT on parking fees.

HMRC says the rules must be applied to all organisations, including the NHS; Northumbria contends that trusts are delivering public activities that are outside the remit of these regulations.

The North East Trust had been unsuccessful in its bids to the lower courts, as part of a case stretching back to 2017.

But now the Court of Appeal has now ruled against the tax authority and effectively overturned previous decisions. It found that trusts were indeed exempt from charging VAT – and threw out arguments that not applying the tax would give the NHS an unfair advantage over private sector operators.

Around 50 similar cases are thought to be linked to the Northumbria case – who are likely to now press for a tax refund of some £70m.

It remains to be seen whether trusts will cut their prices by 20 per cent as a result – or decide to pocket the difference. 

Also on hsj.co.uk today

As the NHS prepares for the release of its annual staff survey results, the challenge lies in leveraging this data to drive meaningful improvements in healthcare, writes Matthew Winn. And the health secretary says there will be “new incentives” to reward NHS trusts to hit efficiency targets and suggests this could involve some form of reinvestment of surpluses generated from productivity schemes.