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

Land of plenty

The government has pledged to stop raiding NHS capital budgets to prop up revenue spending.

But analysis of provider accounts reveal a new type of cap rev transfer has been taking place, thanks to an accounting wheeze which affects the treatment of land sale income.

Last year, £206m (63 per cent) of the £327m raised from land sales helped shore up the Department of Health and Social Care’s revenue budget, rather than topping up its capital account.

This is compared to just £65m (26 per cent) and £80m (34 per cent) in each of the previous two years.

In its response to Sir Robert Naylor’s review of NHS estates, the DHSC said providers would be allowed to keep the proceeds from sales “on condition that they are reinvested in the NHS estate”.

Sally Gainsbury, senior policy analyst at the Nuffield Trust, told HSJ the accounting treatment was, in effect, creating another capital to revenue transfer. She added: “This is not what the general public believed would happen when NHS assets were sold. In their eyes, the money would be there ready to invest in new facilities.”

Lagging behind

Regular HSJ readers will know the Parliamentary and Health Service Ombudsman has had a difficult few years. However, under its current leadership, a new independent report has described the watchdog as moving from a state of “critical care” to “recovery”.

The independent report for the new ombudsman Rob Behrens also notes the PHSO delivers significant value for money and the new leadership is doing good work delivering for the public and stakeholders alike.

However, it also points to the widely known issue of the legislative basis on which the ombudsman works. This legislation is decades old and no longer reflects the world in which NHS patients wishing to complain about services actually live.

Complaints are filtered by MPs, and the ombudsman has no ability to launch its own investigations when it sees an obvious worthy issue. Compared with most ombudsman services in Europe and even in Scotland, the PHSO is, as Mr Behrens puts it, “lagging behind”.

Proposals for the PHSO to be given regulatory powers so it can impose, if necessary, a new complaints system on the NHS will horrify some weary of heavy handed regulation.

But the NHS has singularly failed to grapple with this issue. The complaints process in the NHS is traumatic for bereaved families and it does not deliver for anyone involved.

The NHS has had years to fix this. The warnings were loud and clear in the Francis report about the need to transform the complaints service. No action has been taken.

Giving the PHSO the powers to set the direction and to demand consistent processes throughout the health service feels long overdue.

There is just the question of Parliamentary time – which means we may languish in the current unacceptable position for some time yet.