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.

New NHSI chief revealed

Ian Dalton CBE is the new chief executive of NHS Improvement.

Leaving aside issues like his pay and his four month stint as boss of Imperial College Healthcare Trust for now; he is eminently suited for the role.

With a long record leading health systems and a spell as deputy chief executive of the NHS Commissioning Board before it became NHS England, Mr Dalton is well qualified.

But not many people are jealous – the NHSI job will be very pressured over the next two years.

Lots of hospital chief executives turned the job down as undoable.

Let us count the ways…

It seems highly likely that the provider sector’s Q3 results will show the same sort of downturn they did last year, and from a lower base than last year.

This is before we see more trusts reveal the kinds of financial and financial governance problems seen at Oxford, King’s and Lewisham.

Operationally, the situation is grim.

Even by the flattering “all types” accident and emergency measure, performance continues to get further away from even the lowered targets the service now aims for.

The elective waiting picture is also difficult and getting worse.

The slender budget increase last week will make things even more uncomfortable for Mr Dalton than they were for Jim Mackey.

Few think the £1bn to recover the elective backlog is enough. The A&E £600m is given even shorter shrift.

But the government considers those issues taken care of with its extra money.

The crunchy, publicly visible problems the service will face over the next four months will be occurring at the hospital, ambulance and mental health trusts Mr Dalton is responsible for from Monday.

The tension between the government’s version of reality and reality’s version of reality will be the tightrope he walks.

The budget brings difficult choices

Last week’s budget settlement set the government and the NHS on a collision course, and now there’s no turning back.

At its board meeting on Thursday, NHS England lived up to its post-budget warnings and presented ministers with the impossible choices that the settlement would require.

Firstly it said the additional £1.6bn announced by the government for 2018-19 is less than was requested by NHSE at the time of the Five Year Forward View settlement in 2015 – which appears to directly contradict the chancellor’s budget statement, in which he said the NHS’s funding ask had been “met”.

Because of the shortfall, it added “the NHS will likely not be able to do everything being expected of it”.

If the elective waiting time standard is to be met, NHSE said cuts would need to be made to other services such as mental health, cancer, and primary care.

Jeremy Hunt hit back later in the day - saying government had found extra money, and expected all standards to be met.

Jeremy Hunt’s vision

Health secretary Jeremy Hunt has set out his vision for improving safety of care and in particular the need to standardise care and deliver best practice across the NHS, in an interview with senior correspondent Shaun Lintern.

He singled out as a problem the decades of NHS reorganisation that have delivered a fragmented health system with independent competing trusts and the internal market, making it harder for safety improvements to be adopted quickly by all organisations.

These are interesting comments from a Conservative health secretary, particularly one who came to the post immediately after the Lansley reforms, which arguably delivered more fragmentation and competition than ever before.

Mr Hunt is clearly focused on the issues of patient safety and he reveals in the interview his plans to create new structures to disseminate best practice. It will be interesting to see how this develops.

The health secretary also set out his aims for the new workforce strategy, which he said needed to look beyond the current challenges to those that will be facing the health service in the next 10 years. He also admitted that in the past he and his predecessors had been too focused on short term spending reviews.

Getting real on finances

First NHS Improvement, and now NHS England. The regulators are getting real on the finances.

Typically, NHSE’s finance reports set out the formal forecast position and the risks involved without seeking to cause too much alarm.

But despite the official forecasts pointing to a combined clinical commissioning group deficit only half as bad, NHSE’s chief financial officer Paul Baumann has warned that the likely year end deficit will be more than £500m.

This is explained by the fact that CCGs are not allowed to go changing their forecasts willy nilly – they need to follow a formal process and have it signed off by NHSE.

Only 14 CCGs have so far done this, but Mr Baumann’s warning suggests there are many more in the pipeline.

The warning comes after last week’s budget settlement, in which new funding was announced, but also earmarked for reducing waiting times for emergency and elective.

The NHSE report also mirrors the more pessimistic tone being taken by NHSI, which sounds like it’s given up completely on meeting the planned £496m deficit for the provider sector.