HSJ’s roundup of Monday’s must read stories

Following Monitor’s footprints

The message most heavily emphasised in national NHS planning guidance for this year was that pleading for “system leadership”– for NHS organisations in each health system to work together, setting aside institutional interests. To make this a bit more conceivable, the promise from NHS England and NHS Improvement goes, national bodies will seek to make their judgements across whole health systems, rather than coming down on single trusts, thereby extinguishing any incentive to work together.

Commissioners and providers have till the end of January to group into “health system” footprints which will be used for this system working, and to come to unprecedented agreement over “transformation and sustainability plans” for their area by summer.

What might the shape and size of these health systems be?

We don’t yet know – and fixing planning footprints is a perennially difficult question in the NHS – but Monitor has had a go at using patient flow figures to come up with what it describes as “local areas”. There are 37 of these.

It is highly likely that the footprints which the NHS opts for will in many cases not match these. The last similar exercise came up with more than 100 patches.

In the meantime, we have taken the 37 health systems at face value, and mapped them out– also showing you which ones have the biggest challenge on their hands, because of serious underperformance across a number of areas.

The DH in ‘special measures’

Following NHS Improvement’s letter on Friday night giving a clear ultimatum to providers if they want access to the £1.8bn “sustainability and transformation fund”, King’s Fund policy director Richard Murray has been looking at the strings attached to this redesigned bailout pot.

In his analysis on hsj.co.uk, Mr Murray says that NHS England, NHS Improvement and Department of Health documents on the details of the support package reveal “radical changes to the running of the NHS”.

The “allocations from the fund for sustainability and transformation must be agreed in advance with HM Treasury and DH”.

Mr Murray writes: “The formal and public arrival of HM Treasury into the process for agreeing deficit funding for NHS providers must surely underline the anxiety in central government over NHS finances, and could be interpreted as a Whitehall version of ‘special measures’ for the Department of Health and its NHS partners.

“Rather the opposite to a vote of confidence then.”

There are also operational issues to be addressed alongside the political ones, he observes: “Designing a process that gets the money out to the front line fast could be a challenge in itself, especially if the NHS and Department of Health remain in ‘special measures’.”