The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

On Friday the Financial Times among other reported the findings of the National Audit Office’s investigation into Greensill and supply-chain finance in the NHS.

The NAO’s report looked at two of the NHS connections with what the FT called “the biggest Westminster lobbying scandal for a generation”.

One of the company’s offers was a “Pharmacy Earlier Payment Scheme” to pharmacy contractors.

Another was the “Earnd” scheme whereby NHS employees could draw down some of their salary early from the company, with their employers later paying the firm back.

The company’s business case for the pharmacy scheme said it would save the Department of Health and Social Care £100m a year, a figure chief executive Lex Greensill repeated at a parliamentary committee hearing.

The NAO said DHSC had been “unable to provide evidence of realised benefits” from the scheme.

The early payment scheme was taken up by seven trusts including the Royal Free London and Salford Royal FTs. Northumbria Healthcare FT chief executive Sir Jim Mackey appeared in promotional material the company produced in March last year but his trust did not take up the offer.

Neither staff nor employers were charged for the service, although trusts were also offered the company’s “signature” supply chain finance product.

Again, there was no take-up. Now, NHS England is again looking at salary advance schemes for NHS staff, with a new set of suppliers for this service still being decided on.

Retirement and ‘abysmal productivity’

On Friday The Guardian carried an analysis of NHS Digital figures that showed 23 per cent of GPs are aged 55 or over, with “the average age at which doctors retire [now being] 59”.

The news came after months of rows between the government and primary care over face-to-face staffing and other issues and as the government faced widespread criticism in the health world for not having clear funding for a workforce plan.

Meanwhile the Telegraph’s leader asked “How can the Tories now at least start to reform the NHS and other state institutions to justify the amount of taxes they are pouring into them?”

Seeming to forget the service has recently been weathering a pandemic it said they must “at least get a grip on the NHS and its abysmal productivity”. Sounds like more QIPP on the horizon (and productivity is actually pretty good).

What does the Telegraph suggest? “New entrepreneurial structures outside the main NHS to drive change when it comes to procurement, innovation and efficiency”.

What the heck. It worked for test-and-trace. Greensill was pretty innovative too.

Money pit

Worryingly, on Saturday Matthew Parris, the sensible Times columnist normally firmly on the left of the Conservative party, joined those seeking radical change to NHS funding, under the headline “We can’t go on filling the NHS money pit”.

He believes “voters are ready for a hard look at how we run — and, crucially, how we finance — health services in Britain, a more honest look than either politicians or the media have yet realised”.

In a sentiment more HSJ readers may agree with, he argues: “Voters can see that it’s dangerously jerky to finance our health provision through sudden, enormous, politically-driven dollops of public funds, many provoked by shroud-waving stories of an imminent “overwhelming” of provision.”

He also argues: “Our health sector is growing neither fit nor fat on this. If you do nothing else this weekend, read a lucid 2018 survey by three health think tanks and the Institute for Fiscal Studies. Leave preconceptions at the door. This report, How good is the NHS?, may surprise you.

“Using other rich nations as comparators, the survey shows that we British spend less — yes, less — on our health services, public and private, than most, and in return get health provision that’s somewhat but not disastrously inferior to other nations’.

“Management-to-output figures do not suggest that the NHS is comparatively top heavy or overmanaged, but actual health outcomes are generally under-par and we skimp on staffing, hospital beds and advanced diagnostic and therapeutic equipment. We’re getting a second-rate health service for the price of a third-rate one.”

Private problem

The Sunday Telegraph reports analysis from the Independent Healthcare Providers Network, explaining: “The NHS is sending fewer patients for admission to private hospitals than before the pandemic, despite a £10bn scheme intended to help reduce the backlog by using independent facilities.”

The IHPN, in a move which will presumably not go down terribly well with NHS England, has written to Sajid Javid and to Number 10, to highlight the issue. It states: “The letter, copies of which were sent to Downing Street officials, adds: ‘Despite the welcome introduction of confirmed funding for the second half of 2021-22 to deliver higher levels of activity, many NHS systems are struggling to meet the challenge of achieving higher utilisation of independent sector capacity.

“‘This means that every day, staffed independent sector capacity which could be made available to treat NHS patients is going unused.’” It’s an uncomfortable claim.

NHSE tells the paper is analysis of admitted care, whereas looking also at non-admitted treatments takes activity to 110 per cent of pre-covid.

Vax flex

The Daily Mirror was among those reporting the latest move to try to smooth the disappointing flow of covid booster jabs, by allowing more operational flex to vaccinate “vulnerable groups” such as care home residents ahead of the six-month window. How widely could that flex apply, we wonder. NHS England has certainly turned up the communications volume on jabbing over the past week or so, and is promising a “booster blitz” this week. After predictably sluggish uptake during half term, it also said this weekend that 12-15s vaccines will soon be given in “hundreds more schools”. 

Integration frustrations

A new policy paper reviews the impact of the three major integrated care initiatives of the past 10+ years in England — the integrated care pilot sites of the latter, integration “pioneers”, and new care models under Simon Stevens. 

The findings in the International Journal of Integrated Care are similar to some analyses of the English NHS’ efforts on this front: They are slightly overwhelming, and there is confusion about what integrated care is.

It says: “There was little stable or shared understanding of what ‘integrated care’ meant resulting in different practices and priorities. An increasing focus on reducing unplanned hospital use among national sponsors created a mismatch in expectations between local and national actors.

“Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions.”