HSJ Catch Up: The birth and death of STPs, cyber threat, and Simon Stevens interview

Firing the starting gun, not the STP leader

HSJ considered this week whether STPs are dead or just being born. On Wednesday, Jeremy Hunt and Simon Stevens attempted to send out a clear message that there is life in the sustainability and transformation partnership process.

Hosting an event for STP leaders and other great and good, the NHS England chief executive said he was “firing the starting gun” on STP plans.

Mr Hunt spoke enthusiastically about the new ratings of STPs, forcing a room full of STP leaders to grit their teeth. He also rammed home a wise message, that the great risk about all this was obsessing with organisational form.

Three accountable care system (super STP) leaders gave a good account of how they were working to make things better for patients.

There was something in it for fans of NHS buildings and machines, too, however – to the tune of £325m. This tranche of capital funding – just a “down payment” as Mr Stevens reminded everyone – has been allocated to a spread of improvements/developments from cancer units to primary care hubs; most linked to tricky reconfigurations of some form.

• Expert briefing: STPs, busy being born or busy dying?

Digital dangers

In March, and again in late April, IT departments across the NHS were alerted to a critical security update, or patch, and urged to apply it to most of their Windows computers and servers. Quickly.

Applying these patches isn’t as simple as pressing a button, though there are programmes that make it far easier.

An acute trust will typically run as many as 60 IT systems – some of them older than the trust’s employees.

Our analysis, published on Tuesday, shows at least a fifth of all trusts and likely far more had not moved fast enough when the WannaCry ransomware virus struck on 12 May.

• Expert briefing: Patching the NHS’s IT holes after ransomware attack

Name that forum

We bring you a feast from our latest interview with NHS England chief executive Simon Stevens. The news nuggets include:

• There will be a new NHS national forum, council or assembly of some form, to build consensus around policy questions and difficult decisions. No one knows what to call it.
• The areas subject to the contentious “capped expenditure programme” savings drive are told to “get on with it” – namely, make savings – but the NHS England chief executive acknowledges no more can be wrung out of these “overspending” offenders.
• The NHS will try to find 2,000 additional GPs from overseas in order to give it a chance of meeting the government’s target of a net 5,000 increase by 2020. “At what cost?”, folks will be asking.
• Efforts to raise capital funds from land sales and the private sector won’t deliver very quickly – so the NHS will need cash up front from the treasury next year.

New NHSI chair

Richard Douglas, the former director general at the Department of Health, has been appointed as interim chair of NHS Improvement.

His appointment starts today, when Ed Smith’s tenure ends, and the DH said this will last until 31 December or until “a new chair is appointed, whichever is sooner”.

Last month it emerged that civil servants were vetting a number of candidates for the role, including former chief executive of TalkTalk Baroness Dido Harding. The Conservative peer and wife of MP John Penrose was thought to be a leading candidate.

Health minister Philip Dunne is yet to make a decision on a preferred candidate for substantive chair.

In the woods

At the headline level, the actions taken to “reset” NHS finances last summer have worked in so far as the Department of Health has reported a healthy looking set of accounts for 2016-17.

The revenue underspend of £563m is a significant improvement on the £200m overspend in 2015-16.

But in reality, the position has not changed that much over the last 12 months and balancing the books over the next two years will almost certainly be a tougher task.

Let’s remember that 2016-17 was the Five Year Forward View’s year of plenty, and we’ve now entered the U bend, where income growth reduces significantly over the next two years.

The provider sector was supposed to be in run rate balance by now, but national bodies have had to accept a planned deficit of £500m for the current financial year. Experience from recent years suggests this is likely to be a best case scenario.

• Expert briefing: Healthy headline but NHS is still in the woods

Culture club

The rhetoric over the need for a change in culture in the NHS when it comes to patient safety and learning from harm can seem ever present but intangible.

But there are signs that some practical steps are being taken. Mersey Care Trust has embarked on a “just culture” initiative and is seeing measurable improvements across a range of metrics.

The trust hosted Professor Sidney Dekker, author of the book Just Culture and director of the Safe Science Innovation Lab in Australia last week, and the professor granted HSJ time for an interview.

He was keen to stress that leaders shouldn’t fall into the trap of thinking they can change culture on their own.