HSJ Catch Up: Labour conference round-up and trust merger delayed

The politics of PFI

There are many sides to private finance initiative. 

Obviously, the NHS got some really bad deals in some places. But there are shiny hospitals with contracts for their maintenance where otherwise there might not be.

Jim Mackey bought out his trust’s PFI, and rightly says it is ridiculous not to do it more widely now that interest rates are low.

However, HSJ’s story this week presents some reasons why it would be the contractual/litigation equivalent of invading Russia – not to say it wouldn’t be worth it but it would take a very long time and be hard fought. (We are of course using this metaphor because interest rates are at their lowest level since the Napoleonic wars.)

A good point made by one expert is that as shoddy as some of those deals are, they guarantee the maintenance of the hospital, sometimes at too high a spec, but a guarantee nonetheless.

And let’s not ignore the larger political context of PFI, after the shadow chancellor said a Labour government would bring PFI contracts “back in house”.

People like a grand gesture at a conference, so you can see why John McDonnell said what he did, rather than just announcing a taskforce to make sure all the existing contracts are overseen properly.

In short, they’re not currently monitored properly. This means trusts don’t take easy opportunities to reduce costs.

These are large scale contracts with special purpose companies set up by PFI firms, employing dozens of people. Trusts often employ less than one full time person to monitor these contracts.

Labour vs STPs

HSJ reported the only concrete new announcement in shadow health secretary Jon Ashworth’s speech on Tuesday – the £500m extra it would commit to a winter pressures fund.

The £45bn he mentioned a Labour government bringing to the NHS had been in the manifesto, and (to be technical) that’s £37bn for the NHS, £8bn for social care.

But that will all be the same thing, he promised, as he would scrap sustainability and transformation partnerships and integrate health and social care.

HSJ readers will be aware of the irony of this, given that’s what STPs are supposed to do, but the conference greeted it with a cheer.

The lack of subtlety on the health and social care question was put into contrast by a fringe session run by, erm, Conservative think tank Bright Blue the previous day.

This saw panellists, including Will Hutton, call for some kind of settlement on the issue.

The irony of the triumphal spirit in the conference hall is that the Conservatives’ election campaign was severely damaged by its frankness on the costs of social care, particularly their suggestion that old people might have to pay for some of it from the value of their houses.

No ‘unnecessary’ departures

A couple of weeks ago two chief executives resigned after consistent poor accident and emergency performance in their trusts. Their departures were orchestrated as a clear message to the rest of the NHS, as if one were needed, that the four-hour target still mattered.

So, what happens next?

In Thursday’s NHS Improvement board meeting, Jim Mackey emphasised that the system had been doing “as much as is humanly possible” in recent weeks to prepare for winter, despite ongoing struggles with demand.

HSJ asked Mr Mackey whether we would see any more chief executives depart over emergency performance.

Mr Mackey’s answer was diplomatic: “No one wants to see unnecessary departures of any leaders.”

He continued: “We are a very pressured system. Everyone is trying very hard in very difficult circumstances but we also continue to keep performance under constant scrutiny.

“The answer you want is a definite no. We can’t give that. If performance is really terrible in some places, we will have to act, but that won’t be our first reflex and first action.”

• Comment: The NHS must slow the chief executive merry-go-round

Crunching the numbers

A “growing gap” is appearing in mental health services from the drop in acute adult inpatient beds and fall in community care provision.

That was the message from the Centre for Mental Health in a new report compiled using data from the NHS Benchmarking Network, focusing on adult mental health in England and Wales.

The report found acute adult inpatient bed numbers fell by 15 per cent from a median of 23 per 100,000 population in 2012-13 to 19.6 in 2015-16.

But in conjunction with this, bed occupancy rose from 91 to 94 per cent, staff numbers fell and length of stay increased slightly.

This was coupled with a 6 per cent drop in overall community mental healthcare provision, leading to the charity to call for an “urgent review” by national and local policymakers

NHS England has correctly pointed out that the data pre-dates the Five Year Forward View for Mental Health implementation plan, which it published last July.

Midlands merger pushed back

A merger between three West Midlands trusts to create one of the biggest community and mental health providers in the county has been delayed.

Birmingham Community Healthcare Foundation Trust, Black Country Partnership FT and Dudley and Walsall Mental Health Trust have delayed their integration, admitting their original deadline was too “ambitious”.

In the summer, HSJ revealed the trusts intended to merge by October. However, the trusts have now confirmed they will not be merging until 1 December.