Today’s must know: NHS England gives CCGs strict orders to impose provider fines

Today’s talking point: Mackey backs calls for reduced savings target

Today’s risk: Growth in off-framework agency spending revealed

HSJ’s roundup of Tuesday’s essential health policy stories

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All is not fine and dandy

NHS England has come up with an interesting response to the twin challenges of financial failure and slipping performance standards.

HSJ has learned some CCGs have been given orders to impose strict fines on providers that miss the most important waiting time targets for cancer, elective treatments and emergency care.

Guidance sent to CCGs in the Midlands and East says the usual contractual fines do not offer enough of an incentive for providers to improve, and recommends using heavier penalties worth up to 10 per cent of the total contract value.

We understand CCGs in the South have also been told to impose tough fines. A draft letter instructing CCGs to levy fines was circulated at a national level last week, although it has not yet been sent out to all local commissioners.

NHS Providers chief executive Chris Hopson highlighted the issue in his speech to the organisation’s annual conference on Tuesday morning. He said trusts were unable to manage their finances properly because they don’t know whether the fines will be permanently withheld, reinvested locally, or reallocated via bailouts for financially distressed organisations.

The questions NHS England has so far failed to answer are:

Is there a policy on this for the whole country or are different regions taking different approaches?

And should all money CCGs gain from withholding money from providers in this way be reinvested in services?

Straight talkin’ Jim Mackey

While readers commenting on the new look hsj.co.uk and Twitter were largely unimpressed with NHS England’s instructions on fines, they were complimentary about incoming NHS Improvement chief executive Jim Mackey.

One commenter summed up the mood, telling Mr Mackey his “down to earth plain speaking, not high falutin rhetoric, will win you fans and win the day”.

In an exclusive interview, the head of the new regulator backed recent calls for reduced provider savings targets. He said he “broadly” agreed with his predecessor David Bennett  that 2 per cent is ”closer to what’s doable” in 2016-17.

He continued that there was currently a “level of chaos” at a lot of providers, struggling simultaneously with deficits, declining emergency department performance, and workforce issues.

Mr Mackey said he had recently had dinner with a group of provider trust chief executives, with some in the red for the first time, but “this narrative that we’ve got a load of feckless managers out there who are just deliberately doing a crap job, it’s not right”.