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


There are whole expensive programmes dedicated to making sure the NHS doesn’t get ripped off buying stuff from the private sector. But a lesser known wheeze goes the other way. It turns out the NHS is a terrible customer in terms of paying bills on time, a situation that is getting worse, according to the most recent data.

This can have dire consequences for companies obliged to trade in the real world of business, rather than the NHS’s odd simulacrum of a market.

Some finance directors claim they were instructed to delay payments to suppliers to help ease their cashflow position. An east London trust put patients at risk when they did this last year. A Shelford Group foundation trust (Oxford) similarly tried to sweat its suppliers.

Department of Health and Social Care moneyman David Williams was hauled in front of Parliament’s public accounts committee last year to explain why the NHS treated business so badly. He said then that the DHSC did not condone this behaviour and was encouraging trusts to desist – but also that it was getting worse. (This is a cop out considering the DHSC could compel NHS trusts to comply with the rules). The late payments add up to an unofficial loan from suppliers, one they are often unwilling to challenge the NHS for fear of losing the business forever.

Why are trusts doing this? In many cases, they’ve had their interim funding requests turned down by NHS Improvement or the DHSC, so this is their only option to manage the cashflow that pays staff.

So, something that’s either unofficial government policy or a practice the government has failed to stop is punishing businesses and endangering jobs in the real economy. It wouldn’t take a brilliant lawyer to put a case together on behalf of a firm that did go to the wall as a result of this practice.

The much delayed “one stop shop” for integration

After complaints from suppliers and months of delays (most of the) new framework for sustainability and transformation partnerships and integrated care systems to buy digital and transformation stuff and services has been published.

Over the next four years, NHS England has estimated local NHS organisations will spend £300m through the framework buying tech and support to help integrate regional health and care.

If the 78 supplier list is anything to go by, much of this will money will go to big consultancy firms, commissioning support units and large tech companies.

NHS England has had big ambitions for a “one stop shop” framework for integrated care.

In November last year, Matthew Swindells, NHS England’s information and operations director, also placed the framework at the centre of efforts to digitise providers (the global digital exemplar programme).

He said it would be in place by the beginning of 2018-19.

But it hasn’t all gone to plan.

Initially the framework met with some criticism from suppliers, one describing it as a waste of resources.

The whole thing was “refreshed” and renamed in February, before finally being published this month.

However, a substantial chunk relating to clinical IT systems for hospitals and GPs, including the exemplar programme, has been pushed back again to next year.

Suppliers seem to have come around to it, with several sending out press releases celebrating their inclusion and extolling the framework benefits.

Whether it proves popular with providers will be the real test.