HSJ Catch Up: Another special measures regime and NHS quango overhauled

Special measures for three more trusts

Three more trusts have been placed in financial special measures by NHS Improvement, while some of the worst performers against the headline “control totals” avoided the regime.

St George’s University Hospitals Foundation Trust, Northern Lincolnshire and Goole FT, and University Hospitals of North Midlands Trust will now have improvement directors sent in by NHSI.

The regulator had previously said it was discussing the potential for special measures with 12 trusts, so there are nine others who perhaps came up with a more convincing case for ploughing on by themselves.

Trusts such as King’s College Hospital FT, Royal Free London FT and Hinchingbrooke Health Care Trust might count themselves lucky – judging by their headline performances at quarter three.

NHSI to intervene in A&E performance

If there was any doubt that turning around A&E performance is national health leaders’ current priority, this is surely put to bed with the emergence of a new special measures regime.

Trusts performing poorly against the four hour target could be placed in “A&E special measures” if their performance does not improve by June – as part of NHS England and NHS Improvement’s drive to get the system compliant with the 95 per cent waiting time target by March 2018.

Trusts will be put into one of four groups based on their emergency department performance under the new approach, the letter said.

HSJ was able to reveal who is in which group in London on Wednesday.

A number of measures designed to get the system back on track have already been revealed this month.

First, we reported that from April, sustainability and transformation fund money would only be made available to trusts hitting their A&E targets.

HSJ also understands NHS England and NHSI have now effectively dropped routine financial penalties for many trusts in relation to elective and cancer waits.

NHS Improvement has ordered trusts to reach 90 per cent of patients being seen in four hours by September, and the whole sector must reach 95 per cent by March 2018. The NHS mandate (see below), however, included a slightly delayed target of the end of the 2018 calendar year.

Government demands ‘concrete progress’ on STPs

The government’s instructions to the NHS this year have told it to make “concrete progress” on STPs and to deliver “the productivity and efficiency gains necessary to maintain financial balance”.

The Department of Health published its annual mandate to NHS England on Tuesday – more than three months later than usual. One of the reasons for its delay was vexed debate between government and NHS England over delivery and accountability.

Parts of government have been disappointed that many STPs didn’t produce robust cost saving actions in their first year.

The mandate also includes details of the emergency care improvement plan agreed between government and the national NHS bodies, revealed by HSJ earlier this month.

Major overhaul for NHS quango

Next month, the NHS Litigation authority will change its name and its remit, in a major overhaul announced by Jeremy Hunt.

As NHS Resolution, the body will focus on reducing the number of clinical negligence cases and improving learning from incidents of harm.

The DH is currently consulting on plans for a new rapid redress and resolution scheme for cases involving severe birth injuries.

Troubled trusts charged higher interest rates

The most financially troubled NHS trusts in England are being charged interest rates of 6 per cent on bailout loans from the Department of Health.

Dozens of trusts with income and expenditure deficits are drawing down revenue loans from the DH to maintain payments to staff and suppliers, but these usually carry interest rates of 1.5 or 3.5 per cent.

Barts Health Trust, which was placed in financial special measures in July, confirmed it is being charged 6 per cent on a £54m loan, and 3.5 per cent on another loan of £83m.

Trusts reject ‘impossible’ savings targets 

More than a quarter of NHS trusts have rejected their financial targets for 2016-17, and it’s no wonder once you consider the efficiency assumptions that are built into them.

Analysis by NHS Providers suggests around 60 or so trusts were tasked with delivering average cost improvement programmes of 6.4 per cent, which is more than three times higher than the rate Lord Carter and Monitor thought was possible.

In an NHS Providers’ survey, trusts described their savings requirements as “impossible” and “undeliverable”, and that it would be “irresponsible” for the board to sign up to them.

Of the respondents, there were four trusts that had to reject CIPs of around 10 per cent.

NHSI gives breakdown for unblocking beds

Acute providers last week received yet another letter from Jim Mackey regarding how system leaders plan to bring the A&E performance back in check.

The missive details how many beds NHS England thinks each trust could potentially free up by “proactively” working with councils and maximising the benefits of the £2bn of extra social care cash announced in the budget.

You can see your trust’s estimate here.

The problem, of course, is that it’s not NHS cash and the NHS organisations will have no formal influence over how the new social care funding is spent in the next financial year.

But the message from the centre is clear: get lippy, get proactive and get on with it.