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 just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

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A clear message

NHS political and system chiefs made a rare, very blunt, if not quite united, appeal to the top of government for more money this week – and were clearer than ever that the system faces unprecedented challenges.

At the NHS Providers conference in Birmingham on Wednesday, the health secretary Jeremy Hunt and, directly after him, NHS England chief executive Simon Stevens both said it was no longer possible to argue that more money was not required.

However, beyond the call for more money ahead of the upcoming budget, unity quickly frayed.

Mr Stevens spelled out more explicitly than ever that poorer standards of care – 5 million people waiting for elective surgery by 2020-21 by one forecast – were unavoidable without more cash.

Along the way, he managed to diverge from the health secretary’s position on several fronts.

Mr Hunt had argued just minutes earlier that the government wasn’t beholden to the Vote Leave campaign’s infamous £350m a week for the NHS promise (although, yes, the money would be nice).

Mr Stevens then said people had voted for Brexit at least partly based on that pledge, which did create obligation given the result (so handover the £18.2bn extra a year please).

The SoS was relentlessly focused on the need to improve standards of care further.

The NHS England CEO was blunt that many of gains made in the past decade, particularly around elective waiting times, would be lost without extra cash.

He went far further in his direct challenge to government ahead of the budget on 22 November – though his game will be a longer one going on beyond the budget.

Mr Stevens claimed failure to provide a bigger cash boost next year, perhaps in line with £4bn suggested by several think tanks, would force the government to publicly abolish legally mandated waiting time targets.

He was also clear that he’d yet to win that argument with the chancellor.

He is running out of time to do so.

Mackey blunt on the budget 

Outgoing NHS Improvement chief executive Jim Mackey also fired a warning shot to ministers ahead of 22 November, in his speech to hospital managers at the NHS Providers conference on Tuesday.

Mr Mackey, who leaves the regulator later this year, spoke candidly about the need for a “reset” of expectations about what the NHS should be asked to deliver if no extra money is forthcoming from the Treasury.

He described the health system currently as “juggling hand to mouth”.

While he argued control totals and the STF had been effective policies to improve NHS finances, he said they were only short term measures that “can’t work forever”.

Managers feel the strain

That the overall amount spent on redundancy payments has fallen is good news, but there are still some disturbing stories in the data.

Our analysis of the information from foundation trusts’ annual accounts shows a cohort of FTs with an alarmingly high spend on compulsory redundancies and other severance payments.

Most glaring of which is Northamptonshire Healthcare. In one financial year, the £198m turnover organisation spent more than 3 per cent of its turnover on parting with staff.

It was in the top five spenders on this category for 2016-17 also.

In common with other trusts, it says this was due to a restructure and ongoing savings plans.

Managers in Partnership believe the national redundancy bill will have diminished under pressure from the centre (and those Daily Mail spreads showing senior managers daring to retire and go on holiday). But also because the amount of people available to make redundant has reduced.

Is this a good thing?

Not considering the service is under managed, overall. Don’t just take our word for it, it was widely reported in 2011 by the Financial Times among others.

Meanwhile, NHS Providers chief executive Chris Hopson warned NHS managers’ careers “are being put in jeopardy because they are failing to deliver impossible targets”.

Without significant additional funding, the current performance targets were unachievable and left trust leaders “stuck in an endless cycle of not being able to succeed”.

He called for “recognition and honesty” from Mr Hunt and Mr Stevens about the dilemma facing trust bosses. Mr Hopson said the gap between providers and the centre was illustrated by September’s meeting about improving emergency performance, where some local leaders were made to chant “we can do this”.

Mr Hopson’s warnings were put into worrying context by Jon Restell, chief executive of the Managers in Partnership union.

Mr Restell told HSJ the mental health of under pressure managers is currently MiP’s “number one issue”.

The new Sir Bruce

NHS England named their new medical director on Thursday – Professor Stephen Powis of the Royal Free FT.

As is often the case with these things, he had not been widely tipped for the role in advance but his appointment made plenty of sense when it was revealed.

Professor Powis, a renal specialist, has a number of national roles with various medical bodies and sits on Merton Clinical Commissioning Group’s governing body – so has a better view than most acute medical directors of life on the commissioning side.

He has been medical director at the Royal Free for over a decade, during which time it has emerged as a major player in acute care – and, crucially, one with a reputation for innovation.