The week before Christmas is traditionally a busy time for the health service, on the front line, in the boardroom and along the corridors power. In 2015 it has been no exception, with a number of important policy announcements. Here we round up the must read HSJ stories of the week.
Hope it’s enough
Executive Summary’s tweet of the week goes to Sir John Burn, NHS England non-executive board member and professor of clinical genetics at Newcastle University, for his admirably relaxed take on the complex allocation decisions the board made at its meeting on Thursday.
“NHS England Board has just signed off the plan on how we will spend £560 billion over the next 5 years,” observed one of the leading lights of clinical science. “Hope it’s enough!”
Our coverage of NHS England’s funding decisions includes:
- Real terms cuts for some CCGs and details of a new ‘sustainability and transformation fund’
- A ‘substantial risk’ to specialised care budget
- Big cuts set out for NHS England central budgets
Actual CCG allocations will be published in January, with the official planning guidance document still expected before Christmas.
Our week opened with the publication of a thorough interview with Simon Stevens, which offered some big declarations - like stating that deals on social care and public health were “unresolved business” with the government – as well as announcements on planning priorities for next year and asides such as that public health should not have been transferred to local councils at a time when they’re deep in the financial mire.
One particularly attention grabbing assertion by the NHS England chief executive was that not many areas would follow Greater Manchester in gaining devolved NHS powers and budgets – not even Cornwall, whose “deal” has already been celebrated.
The next day a “devo” deal was announced for London by George Osborne, Boris Johnson, and Mr Stevens himself. It quickly became clear this work was more a case of several pilots involving land sales and integration, rather than actual devolution of anything – although the Chancellor said he hoped this would follow.
Southern Health wake-up call
Even though a draft version of the damning report into Southern Health Foundation Trust leaked last week, the final version still caused shockwaves on Thursday.
The report by Mazars said the trust investigated “too few” deaths in learning disability and older people’s mental health services; the board did not take action on the poor quality of investigations; and these deaths had “little prominence” at board level.
While the full regulatory consequences for the trust were still being decided, the CQC has said it will visit the trust next year and carry out a wider review into the investigation of deaths of people with learning disabilities in mental health and acute trusts.
In the trust’s response, chief executive Katrina Percy said: “Reports such as this challenge not only Southern Health, but the wider health and social care system, and society as a whole… All providers and commissioners of care can learn from this report.”
This is certainly the case, but as HSJ’s patient safety correspondent as observed, currently the regulators and minister have no way of knowing if the problems at Southern Health apply to other mental health and learning disability providers.
How to bring down the agency bill
NHS providers should enhance pay for shortage specialities and offer flexible working hours to staff to tackle their rising spend on agency staff, HSJ’s Workforce Investigation has recommended.
The investigation, carried out with HCL, looked into the causes of the NHS’s growing agency staff bill and had input from more than chief executives, HR directors, medical and nurse directors and finance directors. It’s worth reading alongside the annual survey by HSJ’s sister title Nursing Times, which found 80 per cent felt more pressure than 12 months ago, with staff shortages the main cause.
‘Let there be CCG mergers’
Obsessing about structure? We have to confess guilt, having asked clinical commissioning group leaders whether they believe the unofficial ban on mergers of CCGs should be lifted in our latest barometer survey.
Nearly six in 10 said yes, in the results published on Tuesday. The unavoidable fact is many within CCGs, and elsewhere in the health service, believe such change is needed.
This pressure will only increase as admin budgets are cut further and experimentation with different models for commissioning gathers pace. Our barometer found the most popular avenue of exploration locally is to hand responsibility to accountable providers, with 60 per cent of respondents expecting to do this within 18 months. This was more than the amount who thought they would end up sharing with local authorities via devolution or other means.
However - for now - no removal of the merger “ban” is anticipated, and health systems stretching at their organisational seams are left looking for other options.
Hence, 59 per cent of respondents see themselves sharing more responsibilities and budgets across a group of CCGs. Examples of such clustering can be seen in London, where sub-regional commissioning “sectors” are increasingly important and form the basis of two of the “devolution” pilots announced on Tuesday, and elsewhere.
Such a trend, along with existing CCGs relinquishing responsibilities to accountable providers, will see an increase in the number of groups which, while retaining statutory accountability and governance, do a minimum of tasks for themselves.
These shell CCGs, with most functions delegated or outsourced and barely any staff, will be increasingly common and part of achieving commissioning reform with minimal structural upheaval.
Jumping on the bandwagon
The cover of the final issue of HSJ of the year, out this week, took its cue from the year’s biggest film, Star Wars: The Force Awakens. The age old battle between good and dark forces is front and centre, while a certain Han Salford and the leader of a rebel alliance work on their futuristic new model.
But have we missed out any key characters, and what could they be telling each other? Leave your ideas in the comment section.