HSJ’s roundup of the essential stories on a busy day for health policy

Top of the POHPs

Simon Stevens has set out some early thinking on how funding allocations and system planning could look like after the comprehensive spending review.

During the course of a couple of minutes in a speech on Tuesday morning at the King’s Fund, Mr Stevens cast doubt over the ongoing relevance of the purchaser/provider split, before suggesting that the £8bn funding uplift promised by the government would depend on the ability of every health economy to produce a “sustainability and transformation” plan by next summer.

Thinking is at an early stage, but Mr Stevens suggested a proposal would be jointly put forward by NHS England and the new regulator NHS Improvement to create “nascent health systems” to draw up transformation plans.

These were also termed “population oriented health partnerships” – raising the exciting possibility of a new acronym to add to the pantheon. They will be comprised of providers and commissioners in each local health economy.

There are no details yet on how the geographies will be defined, or what happens in the extremely likely event that not everyone in a local system will completely agree on everything.

Having deployed that bombshell, Mr Stevens then took several swipes at the foundation trust pipeline, which he said is the source of much fruitless “mucking about”, and organisational mergers, which deliver “slightly less than diddly squat”.

Letters instead of life belts

A directive from regulators on Tuesday aimed to clarify “contradictory” messages around financial performance and staffing levels – but appeared to leave many recipients scratching their head.

Five national bodies have told trusts they must “get the balance right by neither understaffing nor overspending”, and that nurse to patient ratios “should not be unthinkingly adhered to”.

It felt to some like a veiled suggestion that trusts should ignore the guidance altogether, but there was no guarantee that they won’t be hammered by the Care Quality Commission if they did so.

One NHS provider chief told us: “The NHS is in a choppy sea, drowning under the weight of demand and debt. Instead of throwing a life belt, the centre sends us letters reminding us of our duty to be safe and not drown.

“And how many regulators does it take to write a letter to state the blindingly obvious?”

Another HSJ reader said: “Contradictory messages have been replaced with fudged message. It’s all down to you, hard pressed local managers…”

Another called for further clarity, saying: “Let’s have Sir Robert Francis countersign this directive then, so we know that it is the right thing to do for patients.”