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.

History repeating?

NHS trusts’ finances are fitting ominously into the pattern that developed last year, despite official claims that the deficit is shrinking.

Although the forecasts suggest their plans are broadly on track, a closer look at the year to date info shows they are laden with risk. Even more so than in 2016-17.

No one should be surprised if the year-end deficit ends up being £200m-£300m worse than the planned £496m, which would be depressingly close to last year’s outturn.

Several large acute trusts have already fallen significantly short of their three month financial target and have notified NHS Improvement of a formal revision to their year end forecast.

One of these trusts, Lewisham and Greenwich, is now having its financial governance investigated by the regulator, while United Lincolnshire has been placed in financial special measures (see below).

But dozens more providers are either saying they can still recover their position, or are only meeting their milestones thanks to heavily backloaded savings plans.

Governance investigation launched

NHS Improvement is investigating financial governance at Lewisham and Greenwich Trust after management consultants raised concerns over how it produced its 2017-18 plan.

The trust, which runs two hospitals in the south east of the capital, is being investigated by the regulator after a report by EY.

The report, produced for NHS Improvement’s national financial improvement programme, was delivered in May and raised concerns “around the process by which the trust’s 2017-18 financial plan was approved”, according to a document seen by HSJ.

The commissioner/provider split

Providers have got the begging bowl out ahead of winter, as is the custom, but instead of waving it at the Department of Health and the Treasury, they’ve stuck it under Simon Stevens’ nose.

NHS England appeared unamused. The national commissioning body issued a statement saying there was “no extra unallocated national funding”.

Trusts needing extra capacity over winter would need to find local savings or “defer other planned in year national trust investment”, it said.

Three’s a trend?

HSJ has revealed that United Lincolnshire Hospitals Trust has a waiting list of more than 600 neurology patients who are overdue a follow-up appointment.

This is the third week running HSJ has reported on a trust with excessive waiting lists of patients overdue follow-up neurology appointments. It follows stories about Burton Hospitals Foundation Trust (1,002 patients waiting for a follow-up) and Shrewsbury and Telford Hospital Trust (369 patients waiting for a follo- up).

So, we now know nearly 2,000 patients are waiting longer than they should for their follow-up neurology appointments across just three trusts.

Battle against fraud in disarray

NHS counter-fraud services are in some disarray, with NHS Protect becoming the NHS Counter Fraud Authority at some point this year (it was supposed to be July).

The name change belies an overall fall in budget and the ignoring of a key recommendation from the City of London Police, whose report into NHS counter-fraud services HSJ unearthed this week.

NHS Protect investigates larger scale cases but local counter fraud services are responsible for everything else.

While acknowledging some good practice, the police report lamented the patchiness of local counter-fraud provision.

The police recommended that NHS Protect more directly manage local counter fraud services but this is not what is happening.

The report also warned against changing the counter fraud training centre in Coventry but this has now been wound down.

NHS Protect is working on other problems the report identified.

Others are unresolved, not least sometimes an obstructive attitude from some providers and no system for checking whether investigations will have major repercussions for services. An example of the latter was the arrest of a gang of corrupt hospital specialists resulting in the collapse of that service across the region.

Southern Health to lose community services?

Southern Health Foundation Trust may not provide community services beyond April 2019.

The trust, which has become synonymous in recent years with shortcomings in care quality and leadership, is said to be in the process of “disinvesting” its community services, according to board papers from neighbouring Hampshire Hospitals FT.

A new procurement for an integrated model of care, replacing the community services contract, which accounts for about a third of Southern Health’s turnover, is on the way.

A Deloitte review has suggested commissioners could take the leading role for further developing the county’s Better Local Care vanguard, which is likely to affect the make up of the new integrated model for community services.

NHS Professionals’ U-turn

The Department of Health has backtracked on selling a subsidiary company that provides temporary staff to trusts.

The DH announced it was marketing NHS Professionals in November 2016 but on Thursday said it will remain in public hands.

The department said none of the bids it received reflected the increasing value of the organisation, which has more than 100,000 clinical and non-clinical staff on its books. Bidders for the company were reported to include temporary workforce firm Staffline, outsourcing firm Serco and a private equity company.

The DH said the costs it incurred with lawyers and management consultants in the sell off, which HSJ reported in July was roughly £2m, will be paid off by the increase in NHS Professionals’ profits.