HSJ’s roundup of the day’s must read stories

‘Disatrous’ breakdown in trust

Ahead of the first strike by junior doctors in decades – they will walk out for 24 hours at 8am on Tuesday– trust chief executives and directors have made known their concerns at the cost of implementing the new junior doctor contract.

Their worries, shared with HSJ on the condition of anonymity, range from the issue of pay protection and expansion of seven day services, to loss of goodwill and morale among the workforce.

One chief executive of a large acute trust said moving to a new contract, based on NHS Employers’ offer to the BMA in November, could cost their organisations “between £1m and £1.5m”.

But they said the bigger cost will be the “loss of goodwill”. “It is a disastrous combination to lose all this goodwill and cost us more money. It worries me there has been a breakdown in trust.”

This was the most common concern among the NHS leaders we spoke to.

“The whole thing has not been handled very well. I am pretty unimpressed with both sides,” another chief executive said.

While a West Midlands chief executive warned: “The ill feeling that is caused by such disputes leaves a long lasting legacy.”

Meanwhile, anexclusive poll for HSJhas found public support for junior doctors’ cause would drop to below half if they refuse to provide emergency care, but overall 66 per cent of the public support Tuesday’s industrial action, which won’t affect emergency care.

Essential reading before the strike

Who got their fair share?

The biggest winners and losers of NHS commissioning cash were revealed on Monday, with several CCG core budgets set for real terms cuts in the coming years.

Financial allocations published by NHS England show that four central London CCGs will be among the biggest losers next year, along with Sunderland and the Isle of Wight.

These six CCGs will get the minimum cash increase of 1.39 per cent, when an increase of 1.6 per cent is needed to keep up with inflation.

Deeper cuts will come in subsequent years, as NHS England accelerates the redistribution of funds from overfunded areas.

CCGs deemed to be among the most underfunded will see sharp rises in funding next year. Bedfordshire will receive the largest increase, of 9.7 per cent, followed by a 9.4 per cent increase for Corby. Thirty-eight groups will receive an increase in their core allocation of more than 5 per cent in 2016-17.

Hear Hunt’s call

Lord Hunt’s call for the National Audit Office to investigate the dramatic collapse of an £800m NHS contract in Cambridgeshire is pertinent.

The bodies involved in the fiasco – which saw NHS-owned UnitingCare Partnership hand back its contract to Cambridgeshire and Peterborough CCG just eight months into the five-year deal after it was deemed financially unsustainable – need to be held accountable.

But, more importantly, the NHS needs to know what went wrong – and quickly – so lessons can be learned for the benefit of the service, both locally and nationally.

The CCG has pledged an internal review and NHS England has said it will carry out an “external review”, but little is known yet about the terms of reference or if the review will be made public.

A transparent public inquiry from a genuinely independent agency such as the NAO would, however, provide the required level of scrutiny to ensure lessons can be learned and shared across the system.

Similar outcomes based commissioning projects are going on across the country, for example Oxfordshire’s adult mental health services and musculoskeletal services in Bedfordshire, so it is important they do not fall over the same, as yet unknown, hurdles as in Cambridgeshire.

Meanwhile, Cambridgeshire, one of England’s most financially challenged health economies, is set to undergo major service reconfiguration in an attempt to close a system wide deficit of £250m by 2018-19. This is a huge challenge and neither commissioners nor providers can afford to make the same mistakes again.