Your essential update on health for the week

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Budget is no laughing matter

The chancellor cracked several jokes during his budget statement, but few in the NHS seem to share his sense of humour. Many are unhappy with the health service’s lot as announced by Philip Hammond on Wednesday afternoon.

Mr Hammond said there would be £2.8bn of extra revenue funding for the NHS to cope with pressures between now and the end of 2019-20. The new funding is “exceptional”, which suggests it is non-recurrent and cannot be budgeted for in future years.

The money will be split over three financial years, with one-off and non-cumulative increases to the existing planned budgets in each year. The current year’s budget will increase by £335m, purportedly to help the NHS cope with winter pressures. The budget that was previously planned for 2018-19 will increase by £1.6bn – due to be split between elective care recovery and emergency – with the 2019-20 planned spending limit rising by £900m.

The health sector had insisted an extra £8bn was needed over this period just to maintain day to day services, while the major think tanks agreed £4bn was needed next year alone. NHS England chief executive Simon Stevens also appeared to support an uplift of this order.

HSJ editor Alastair McLellan’s verdict is that this budget and Jeremy Hunt creating unrealistic expectations for the service “put the government in direct opposition to the views of the NHS leadership”.

Sir Bruce Keogh said his “personal view” was: “The budget plugs some, but definitely not all, of NHS funding gap. Will force a debate about what the public can and can’t expect from the NHS. Worrying that longer waits seem likely/unavoidable.”

Meanwhile, even some of the “winners” of capital made clear their displeasure with the budget’s bigger picture.

Twelve STP projects will receive the first share of £2.6bn in capital, splitting £260m between them.

Two trust bosses who also lead two of the STPs receiving money were blunt on Twitter.

Birmingham Women and Children’s FT chief Sarah-Jane Marsh said her reaction to the settlement was “one of extreme sadness. Some very difficult conversations ahead.” While chief executive of South Warwickshire FT, Glen Burley, warned: “We will have to make some choices about what we don’t do in the future.”

Half-time report

NHS trusts must reduce their combined monthly deficit to £107m to meet the official forecast figures in the second half of 2017-18, after recording a monthly deficit of almost £300m in the first half of the year.

According to analysis of official mid-year data by HSJ, more than 60 trusts have fallen behind their financial plans in the first six months, while dozens more must deliver significant run rate improvements to hit their forecasts.

Despite this, just 20 trusts made downward revisions to their forecast outturns after the first half of 2017-18.

As reported last week, the official forecast suggests a trust sector year-end deficit of £623m, compared to the planned £496m. But NHS Improvement admitted there are “significant risks” to delivering this position due to heavily “backloaded” savings plans.

HSJ Awards 2017 winners

Nearly 1,700 people gathered for the HSJ Awards on Wednesday night, where 23 gongs were handed out by Sir Lenny Henry in a celebration of the finest achievements in the NHS.

Among the blue ribbon winners were chief executive of the year Tom Cahill, from Hertfordshire Partnership University Foundation Trust. The judges called him “an authentic, inspirational leader”.

Organisations taking back a trophy included Northumberland, Tyne and Wear FT, which won provider trust of the year, and Hull Clinical Commissioning Group, which took CCG of the year.

A total of 224 entries were shortlisted for the awards, with the final 23 winners selected by 85 judges.

Detailed case studies of all the shortlisted entries can be found over at HSJ Solutions.

New care models success

Areas covered by new care model vanguards saw lower growth in emergency admission rates than the rest of England during 2016 and 2017, and a fall in the GP referral rate, analysis by HSJ indicates.

We looked at activity in 16 CCG group areas that, according to NHS England information, had a national vanguard site covering the majority of their population.

Comparing GP referrals in 2015-16 and 2016-17 per 100,000 population, the vanguard CCGs saw a 1 per cent decrease whilst non-vanguard CCGs had growth of 1.6 per cent.

On emergency admissions, the vanguard CCGs saw a 0.8 per cent increase. Across all other CCGs there was an increase of 1.9 per cent. However, the vanguard CCGs began with a substantially higher rate than the other CCGs.

A number of factors could be behind activity trends, but the finding appears to support NHS England’s claim that in aggregate vanguards are seeing slower activity growth than other areas. HSJ’s analysis also found some non-vanguard areas had seen greater reductions in emergency admissions, however.

While emergency admissions are seen as a key litmus test for success of whether new care models can moderate demand and costs; many of them have also focused on developing links between primary and secondary care which could reduce GP referrals, and building outpatient type services away from hospitals.