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.

Pathology networks under the microscope

As hospital managers brace themselves for busier emergency departments over winter, activity within another service away from the front door is gathering pace.

The thorny question of pathology consolidation is back on the agenda after NHS Improvement published proposals for new networks of trusts’ laboratories, which the regulator hopes will deliver savings of up to £200m.

NHSI’s announcement came at an awkward time for some trusts, which had already invested time and money planning and costing their own networks.

Four trusts in the Black Country and another three or four in Lancashire may have to change detailed plans for their networks to accommodate more trusts in line with the regulator’s proposal.

A quick search of the latest available board papers reveals other trusts expressing a wish to pursue a different option than that proposed by NHSI.

Once agreements have been struck there is the small matter of implementation.

New Royal College of Pathologists president Professor Jo Martin has flagged up concerns over IT and workforce, and overcoming these will be key to the success of the whole programme.

Black Country shake-up

It’s been a busy week for the Black Country with one partnership being formed and another put on ice.

After holding out for two years, the Royal Wolverhampton finally joins the Black Country Alliance. Having initially declined to join the arrangement formed by Sandwell and West Birmingham Hospitals, the Dudley Group and Walsall Healthcare in 2015, Wolverhampton has decided to join them. The only condition being that the alliance changes its name.

Now called the Black Country Provider Partnership (not to be confused with the mental health trust with a similar name), this new power marriage is set to reign over all acute care in the Black Country.

The partnership comes as all four trusts attempt to consolidate their pathology services. The trusts are predicting it will save them £6.7m a year. The target model for the merger is to have a central hub based at Royal Wolverhampton and three smaller labs for urgent diagnostics at the other trusts.

While one union was formed another has been paused. The highly anticipated merger of Birmingham Community Hospital, the Black Country Partnership; and Dudley and Walsall Healthcare Partnership, has been temporarily iced. This merger was a significant cog in the sustainability and transformation partnership’s plans for mental health and the reasons for its pause are unclear. 

The bottom line on winter

Trust leaders have called for a significant proportion of the £335m winter pressures fund to boost the bottom line of hospitals that have already purchased extra capacity.

Discussions are ongoing around the extra money, announced in last month’s budget, which the government expects to help the NHS improve performance against accident and emergency and elective waiting time standards.

Trusts were told to submit bids for a share of the funding by 1 December and system leaders are expected to finalise allocations by next week. The allocations are being drawn up by the national urgent and emergency care directorate, led by Dame Pauline Philip, who works across NHS Improvement and NHS England.

HSJ understands a majority of the funding, around £200m, could be used to fund extra capacity that some trusts have already been adding in preparation for winter. 

The remaining money would potentially be spent on new capacity such as social care packages.

Merger on the Mersey

The tentative merger between Liverpool’s two acute providers has begun to get serious.

Two years after deciding they are better off together, the boards of Aintree University Hospitals Foundation Trust and Royal Liverpool and Broadgreen Trust have now approved an outline business case.

Regulators are due to visit the trusts this week to review the plans, after which there will need to be a submission to the Competition and Markets Authority and a full business case approved.

If the financial estimates used to support plans are correct, the trusts could really do with moving things up a gear.

According to a recent loan application from Aintree, a report commissioning from McKinsey in 2014 reckoned that a merger and clinical reconfiguration between the trusts would release annual savings of 12-14 per cent on their combined costs of almost £900m.

Trusts with experience of mergers, or researchers who have studied them, would probably suggest savings of that order are a tad hopeful, but even a fraction of that would come in very handy.

Nursing vacancy numbers

There are at least 36,000 vacancies for registered nurses in the English NHS, according to a new official analysis which has provided the first accurate picture of the issue for several years.

NHS Improvement has told HSJ it has been collecting monthly information from trusts since April 2017 and cross referencing the figures with other centrally held data sets to draw up the most accurate picture of nursing vacancies affecting the NHS. 

The regulator has been asking trusts to provide vacancy data as part of their monthly returns. Officials have compared trusts’ reports to their annual operating plans, actual staff in post, and the financial returns to provide an upper and lower limit of vacancies.

The results show the NHS has at least 36,000 full time equivalent nursing vacancies but the number could be as high as 42,000.

NHS trusts used to be required to submit vacancy data as part of official statistics but this has not been the case for several years.