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.

The decision to discharge hospital patients to care homes (where they could not go home but were fit for discharge) in the early stage of the pandemic turned into one of the most controversial of all decisions in the last 18 months.

NHS England has repeatedly denied a link between the discharge policy and the deaths of thousands of elderly people, and stressed that it was following government/Public Health England policy on testing, while Matt Hancock famously insisted the government had thrown a “protective ring” around the care homes.

Those viewpoints will now be tested in court this week by a landmark court case brought by the families of two people who died in care homes.

The legal action is being taken against NHS England, Public Health England (now the UK Health Security Agency) and the Department of Health and Social Care, with the families saying they “need to find out what happened” to their loved ones.

Given the sensitivity of the topic, the case could stir up tensions again between the government and NHS as parties look to defend themselves, and may end up pointing the finger elsewhere when it comes to apportioning blame.

GP access latest

Speaking of sensitive topics, few NHS debates have become so rapidly polarising as the recent furore around GP access.

Last Thursday, in the way of the latest intervention from government/NHS England, new NHSE CEO Amanda Pritchard attempted to placate irate Daily Mail readers with an op-ed setting out plans to increase face-to-face appointments — and declaring primary care is a personal priority, while Sajid Javid took some flak for missing his own in-person appointment at a GP conference.

End of the pay freeze?

It’s only nine days until the government’s spending review, which means the usual pre-announcement briefings and leaks are expected in the coming days.

One such scoop was given to the Guardian last week which, in good news for NHS staff, reported that Rishi Sunak is poised to end the public sector pay freeze.

The pay freeze was imposed last November when Mr Sunak said it was unfair for public sector workers to get a pay rise while many private sector staff were either furloughed or losing their jobs. However, Boris Johnson’s promise of a “high-wage economy” at the Conservatives’ conference earlier this month appears to signal a thumbs up from the Treasury – the Guardian reported.

Although lower paid NHS staff were exempted from the pay freeze — and all Agenda for Change staff received a small increase this year — an end to the policy will be a welcome boost for all staff after 18 months of the pandemic.

The capital conundrum

Another policy area health chiefs will follow closely is the size of the capital budget for health and social care.

Managers have repeatedly called (without success) for a multi-year capital settlement in the past, but the three-year spending review finally offers a chance to provide some longer-term certainty about how much money will be available until 2024-25.

How much capital does the NHS need? Opinions vary, but the NHS Confederation last week called for a £1.8bn increase up to £10.3bn by 2024-25 – following a detailed report on NHS funding projects by the Health Foundation last month.

Alongside its plea for extra capital, Confed published a snap survey based on results from a fifth of trusts which found long-standing complaints about how the NHS receives capital continue to frustrate local managers.

In two examples, 77 per cent of respondents said they could not access allocated capital in a “timely way”, and 71 per cent said it was “not straightforward” to get their capital project approved.

The government’s 2019 Health Infrastructure Plan pledged to simplify the capital allocation process, but Confed’s survey indicates little change has happened so far – which means the spending review offers another chance to fix this long-running problem.