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

Winners and losers on finance

At 00.01 Thursday NHS Improvement released the financial and performance results for the trust sector for 2017-18.

They were not pretty reading, with a significant overspend on staff, sliding access performance and some eye-popping deficits at individual trusts.

The Nuffield Trust’s Sally Gainsbury warned that the true deficit figure across the sector was closer to £4bn. Other commentators said the mismatch between what the NHS was being asked to do and what it was being funded to do was becoming clearer and clearer.

At a micro-level, individual trust performance on finance showed how difficult planning can be, with one trust’s position slipping by £90m compared to what was predicted at the start of 2017-18.

King’s College Hospital Foundation Trust’s slide was dramatic but it was not the biggest single deficit, with Barts Health Trust ending £130m in the red (although Barts were allowed to access its STF funding anyway).

Elsewhere, trusts ended up with large surpluses after land-sales meant they hit their STF targets and dragged more STF out of the centre.

Whatever its earlier success in helping distressed providers, the extremes of surplus and deficit the STF double-jeopardy produces make NHS finance ever more bizarre.

Safety in the independent sector

The Ian Paterson case, which saw a disgraced surgeon jailed for 20 years last August, brought unprecedented scrutiny onto the private healthcare market – a market that isn’t hugely private, considering the NHS makes up roughly 40 per cent of its revenue.

In an interview with HSJ this week, the medical director of the NHS Partners network (the part of the NHS Confederation representing independent providers) said not only that private hospitals were “willing to learn and improve”, but also that they would do so quicker than their NHS counterparts.

Howard Freeman also rejected any suggestion the sector took the easier, more profitable cases and said in some cases the NHS was to blame for a lack of transfer arrangements if something went wrong in a private hospital.

The interview comes after warnings on patient safety in independent hospitals from the Care Quality Commission and Jeremy Hunt.

Backtracking on rationing

The Equality and Human Rights Council rarely features in HSJ but Sharon Brennan reported on 13 clinical commissioning groups U-turning on a funding decision after the threat of legal action from the EHRC.

The council had written to the CCGs in March warning them their proposed policies on the care of people with some serious long term health conditions might be unlawful and “dehumanising”.

NHS continuing healthcare budgets pay for community care for people with conditions or disabilities with a primary medical care need.