Your essential update on the week in health

HSJ Catch Up

This new 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.

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Major changes in NHS finances to happen

In his speech at the NHS Confederation conference, Simon Stevens said there would be a “re-set” on NHS finances next month. As HSJ reported, this is expected to be a major intervention, with substantial input from government.

In our finance expert briefing, David Williams writes that while HSJ reporters were at Confed they “detected from many senior leaders a profound unease about what next month will bring. There was a palpable sense of the collective breath being held”.

Mr Stevens said he was trying to send a “Bat signal” to let people know a significant move was coming up. A new post-spending review deal is in the process of being agreed between NHS England, NHS Improvement, the Treasury and Number 10. That and purdah (lifted on Friday) have prevented much being said openly to date.

The future of hospital chains

In last week’s expert briefing on new models of care, HSJ’s David Williams set out eight policy questions on hospital chains that need answering.

This week, the leading architect of hospital chains, Sir David Dalton, has answered them.

Sir David said: “The group must be capable of functioning when one or more local organisations has a poor rating or experiences poor performance.

“Otherwise there is no incentive for groups to support troubled organisations. I would expect similar CQC inspection arrangements to those currently in place in non-NHS groups/chains.”

Sir David’s thoughts are reproduced in full in this week’s edition of What’s New In Care Models.

Directors under pressure from regulators to agree to financial control totals

Finance directors in the NHS are being put under pressure from NHS regulators to agree to overly optimistic financial assumptions and to agree to “fundamentally unsustainable” financial control totals for 2016-17, according to a leaked letter authored by the boss of the Chartered Institute for Public Finance and Accountancy.

The letter said concerns had been raised “by CIPFA members across the health sector regarding the external pressure which is being placed on them by health regulators. Among their number are members who have been involved in the transaction reviews over year-end 2015-16 and those who are struggling to sign up to control totals for 2016-17.”

The letter follows HSJ reporting earlier this year that an NHS finance director wrote to MPs to warn that hospitals could come under pressure to “cook the books”.

The debate behind CCGs

No CCGs have merged since they were unofficially banned in April 2014, and NHS England has not said it will now allow mergers (well, it has behind the scenes, but formally it hasn’t).

Last week ago HSJ editor Alastair McLellan published an editorial with the headline “Many CCGs are not fit for purpose and must be reorganised”.

A few days later at the NHS Confederation conference, NHS England non-executive director Lord Victor Adebowale said STPs were not a response to the fact that in most health economies, CCGs were not able to fix underlying problems. That seems odd, because if CCGs are on the verge of fixing those underlying problems, then why on earth did NHS England bother with all this flapping about with STPs? (Lord Victor has since admitted to not reading the leader he disputed.)

NHS Clinical Commissioners co-chair Graham Jackson, also chair of Aylesbury Vale CCG (which, incidentally, wants to merge with its neighbour), has written a direct response to Alastair’s piece.

Dr Jackson accuses HSJ of “very unhelpful rhetoric…claiming firstly that what is really needed in the NHS is another structural reorganisation and secondly that sustainability and transformation plans can effectively be seen as replacements for clinical commissioning groups”.

The editor points out beneath the article that he didn’t quite ask for a wholesale reorganisation and didn’t say CCGs would disappear.

Possible structural change in STPs and LDRs

There are 44 sustainability and transformation plans, and, at last count, 83 local digital roadmap groups.

This situation, admitted Paul Rice, NHS England’s head of digital strategy, at a Westminster Health Forum event on Wednesday, is a “mismatch” that needs to be “worked” on.

The lack alignment between the all-important STPs and their digital counterparts – the LDRs – which involve drawing up blueprints for paperless at the point of care services by 2020 is a problem.

Mr Rice did not elaborate on what exactly needs to be done, but Beverley Bryant, now at NHS Digital but until last month NHS England’s director of digital technology, told HSJ in April that any restructuring to LDR footprints would be a “local decision”.

STPs could face mental health veto

Two NHS England directors have warned that local sustainibility and transformation plans could be rejected if they cannot show how they would improve mental health services.

The national director for mental health, Claire Murdoch – who also leads Central and North West London FT – told a session at the NHS Confederaion conference last week: “I think that it’s the job of NHS England and NHS Improvement not to approve any STP, not to pass it, unless it can show the golden thread of early intervention, psychologically minded approaches to health and good services for people who have mental illness.”

The 44 STP footprint areas were asked to submit to their initial plans to NHS England by the end of the month.