Your essential update on the week in health

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.

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NHS England announces measures to curb costs

Last week NHS England announced new controls on hiring expensive interim directors, including a £600 cap on pay per day.

But this week, HSJ revealed the national body has authorised Kernow CCG to spend £396,000 on an interim turnaround director.

Kernow, which is currently subject to legal directions, said the figure includes agency fees and contractual payments to employ a turnaround director “during the current financial year”, although the actual length of the appointment is still subject to agreement.

The post has been filled by Keith Pringle, who has previously worked with CCGs in Hampshire and at Gloucestershire Hospitals Foundation Trust.

NHS England’s area team for the South said the appointment is a crucial element in “strengthening capacity” to recover the CCG’s financial position, and it was encouraged by the early progress.

The situation has split opinion among HSJ readers, with one saying: “The amount of money spent on interims is obscene, no wonder the NHS has no money.”

But another added: “The nature of the work means it’s difficult and unpredictable and needs someone with experience. These people cost money. If it was easy, we wouldn’t be in this mess.”

Overspending predicted for commissioning budget 

A large underspend by NHS England tipped the financial scales back into an area of acceptability in 2015-16, but this helping hand is unlikely to be available this year.

The national body is forecasting that its overall commissioning budget will be overspent by £83m in 2016-17, which would be its first overspend since it was formed in 2012.

NHS England’s underspend of £599m last year helped the Department of Health avoid a humiliating parliamentary process over its accounts, so this year’s forecast places even more importance on reducing the provider deficit.

There is often significant fluctuation in the underspend/overspend figure, and NHS England says it is pulling out all of the stops to achieve “financial balance”.

Types of MCP contracts revealed

The new multispecialty community provider contract will have three different forms and last 10 to 15 years, NHS England announced on Thursday.

NHS England’s framework for MCPs, set out three potential routes for contracting an MCP:

  • an alliance contract between various providers;
  • a “partially integrated” contract – under this version GPs will be able to retain their general medical services contract alongside the MCP contract; and
  • a “fully integrated model” – this will be a “hybrid” of the standard NHS contract and a contract for primary medical services.

Colchester chief executive: trust’s problems ‘worse than I thought’

A penny for the thoughts of senior managers at Colchester Hospital University Foundation Trust, after the troubled hospital’s new chief executive issued a damning assessment of his new fiefdom.

Nick Hulme, who is now chief executive of Colchester in addition to his existing role running Ipswich Hospital Trust, told HSJ: “The scale of challenge in terms of governance, operational improvement, quality, safety, culture are much greater than I had imagined.”

Mr Hulme told HSJ he envisages a merger between his trusts within the next two years. But the new broom, who started in May, is clear that a lot of patient safety, operational and governance issues must be addressed before going through such a move is credible.

A long, windy and bumpy road lies ahead for the trust, which received a stinker of a Care Quality Commission inspection report earlier this month in which it was rated inadequate overall and inadequate in four of the five core inspection areas.

CQC chief responds to reset

CQC chief executive David Behan said he would choose to ramp up waiting times rather than see a drop in care quality if he was in charge of a trust, following last week’s “reset”.

Mr Behan also had to apologise after 500 documents in the CQC’s possession, potentially including information about people’s previous criminal convictions and cautions, were accidentally thrown out after a cabinet was wrongly removed during office refurbishment.

The regulator will commission an independent review of its security arrangements.

DH accounts have ‘little or no wiggle room’

The Department of Health accounts, released during last week’s policy bonanza, “have rarely made such interesting reading” – so say Anita Charlesworth and Richard Murray.

The Health Foundation and King’s Fund experts have got stuck into the minutiae of the 2015-16 documents in a comment piece on, and importantly look at what it means for the NHS in 2016-17.

They warn that “most of the funding for transformation has been eaten up by the imperative of financial stabilisation”, and “the DH and commissioners have little or no financial wriggle room” in the pursuit of efficiencies.

So what comes next? “To deliver control of the money requires a real handle on the underlying resources – namely workforce,” say Charlesworth and Murray.

“Somewhat counterintuitively, to deliver control the NHS needs more permanent staff – but it also needs to focus on workforce productivity. This must lead to a single-minded focus on using the skilled workforce well.”

NHSI: Pay bill list was intended to start discussions

NHS Improvement has told HSJ that its list of trusts with high pay bill growth was “intended to start a discussion” and the organisations are “not being targeted for cuts to their workforce”.

Chief executive Jim Mackey issued a statement to clarify its position following the NHS financial reset announcements last week by NHS Improvement, NHS England and the CQC.

The reset document included a list of 63 trusts which, it said, according to NHS Improvement’s analysis, had seen “significant growth” in their pay bill “in excess of inflation and pension effects” since 2014.

HSJ has reported that it was understood that where trusts could not justify this growth to NHS Improvement, they would be required to make additional savings, and that some had been told their control totals may be revised.

However, Mr Mackey’s statement says that it is “incorrect to suggest that providers will be penalised financially over pay growth”. He also said it would be “unworkable and unsafe” to suggest that the entire “excess” identified in the document, of £356m, should be cut from pay spending.

Mr Mackey says in a statement: “There are legitimate reasons why individual providers may have reported recent growth in pay costs, taking on new services or addressing concerns raised by the [CQC] for example. We will work with providers and the CQC to identify where savings can be made without compromising patient safety.

Earlier in the week we reported objections and concerns raised by chief executives of several trusts on the list, including that the analysis did not account for where there was a historical baseline of poor staffing, increases in activity, or changes to services.