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 just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Impact of Carillion collapse

The sudden demise of Carillion has cast uncertainty over the services provided and contracted by the company to the NHS.

It is too early to say precisely what the implications are for each of the 14 trusts affected but HSJ has found some consensus of opinions after speaking to industry experts.

Given that Carillion was subcontracted by private finance initiative providers to run or contract services to 13 of the 14 trusts, it is the PFI providers who face the most immediate problems.

They are now tasked with finding new contractors who will take over the construction, maintenance, cleaning, cooking and other facilities management services for the trusts.

This pressure is particularly high for the companies set up to deliver the two new PFI hospitals in Liverpool and Birmingham.

One issue those PFI providers will need to navigate is the question of who takes on liability for the construction work carried out by Carillion.

The biggest losers currently are the many businesses owed money by Carillion, many of which will take a severe hit.

CQC chief to exit

Sir David Behan has announced that he will step down as chief executive of the Care Quality Commission in the summer.

Sir David joined in 2012, at a time of huge controversy about the behaviour of and standards at the regulator. It has made substantial changes to how it works under his leadership, many in response to the Francis inquiry into events at Mid Staffs.

These included comprehensive inspection and ratings of NHS trusts, GP practices and other health and care providers. 

The CQC is to begin recruitment for a successor imminently.

CCG refuseniks

Clinical leaders across three sustainability and transformation partnership patches are defying public health guidelines and refusing to commission flu antivirals on grounds of cost effectiveness, HSJ revealed on Thursday.

The Northern Clinical Commissioning Group Forum, covering the North East and North Cumbria, wrote to NHS England earlier this month to say it would not pay for antiviral drugs for influenza.

The decision follows a letter from NHS England telling CCGs it was “urgent” they commission appropriate assessment, prescription and supply of antiviral drugs.

In the letter to David Geddes, head of primary care commissioning at NHS England, South Tyneside CCG chief executive David Hambleton said the evidence for antivirals was “very weak”; cited a Cochrane review, which he said found “very little benefit” from using antivirals; and said it was not “cost effective” to commission them.

The decision defies both Public Health England and National Institute for Health and Clinical Excellence guidelines, which recommend the use of antivirals during winter months.

But judging from its initial response, NHS England does not look like it is going to heavily sanction the 12 northern CCGs or demand they reverse their decision.

What is not clear is if this will set a precedent for commissioners nationwide, who may follow suit if they believe spending on antivirals may now represent a quick and easy saving.

Better the devil you know

The admission by the joint chief executive of three Essex trusts that running the three sovereign entities as a group has proved “cumbersome and inefficient” raises further questions about the group model.

The closely watched unprecedented Essex group model involved the trusts that run Basildon, Chelmsford and Southend hospitals remaining statutory independent bodies but having a joint leadership team and “flexible workforce”.

But trust leaders have also found themselves frustrated by bureaucratic burdens arising from the new group model, and establishing the scrutiny and accountability framework proved even harder. Two non-executive directors went as far as resigning such were their concerns around the governance of the new model.

Trust executives have now decided the best way out of this considerable pickle – not helped by deteriorating finances at Basildon and Mid Essex – is to go for a conventional merger, as revealed by HSJ last week.

The other original foundation trusts given permission to experiment as “FT group leaders” by NHS Improvement were Guy’s and St Thomas’, Northumbria Healthcare, and the Royal Free London FT, progress on which is being watched by other sector leaders contemplating how best to further collaborate.

But other models are available – it is not a binary choice between a group or conventional merger.

University College London Hospitals FT’s chief said last year that he did not think the chain model would work – and outlined concerns about precisely the sort of governance issues experienced in Essex. His trust would instead look to form provider “alliances” and shared service agreements.

Pay bar raised

The pay threshold for very senior managers in the NHS is no longer tied to the prime minister’s salary and has been increased by more than £7,000.

The threshold has been raised by the Treasury from £142,500 – the prime minister’s annual wage – to £150,000, as part of a new senior pay transparency policy. Trusts will still need to seek permission for appointments and pay rises above this amount.

In June 2015, Jeremy Hunt set out rules for trusts about the appointment of new senior managers being paid more than £142,500, saying these must be approved by the Treasury.

Last year, HSJ revealed that the thresholds were largely ineffective at holding down pay with nine out of 10 requests to pay more being approved in 2016-17.