Your essential update on the week in health

HSJ Catch Up

This new 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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Treasury tightens grip

The Treasury’s grip on NHS finances is becoming ever more apparent.

Since the start of 2016 we have seen HMT demand sign-off on £800m worth of clinical commissioning group budgets, as well as payments to providers from the £1.8bn sustainability fund.

And now the squeeze looks to be tightening on providers’ capital budgets, with local leaders told to scale back their spending plans for the year.

In a presentation document from an NHS Improvement event, seen by HSJ, trusts were warned that “pressure [is] increasing for capital controls with HMT direction possible because of the current forecast – finance directors to review assumptions urgently”.

There is of course a growing backlog of maintenance problems on NHS estates, while many of the 44 regions drawing up sustainability and transformation plans are likely to put forward a case for significant capital investment in order to transform services.

The document suggests NHSI and the Department of Health have been making this argument to HMT, with the subject said to be “under discussion”.

Junior doctors lose in court

There will be very few senior figures in the NHS who did not expect junior doctors to lose their High Court showdown with the government.

It was always the case that individual employers would introduce the contract when doctors rotated to their new jobs and any suggestion Jeremy Hunt had acted illegally seemed far fetched.

So it came as no surprise to most commentators who have followed the dispute that the junior doctors lost their court action.

Mr Justice Green could not have been clearer in his judgment on Wednesday afternoon that the health secretary had acted lawfully: “I have concluded that the decision adopted by the secretary of state fell squarely within the scope of his lawful powers…

“When all the relevant material is read objectively and in its proper context there is no lack of clarity or transparency.”

There was some deserved criticism of Mr Hunt for his loose language in Parliament, which had allowed doctors to misunderstand how the contract was being introduced. HSJ has previously chastised Mr Hunt for this during the course of the dispute.

Last days of payment by results

Simon Stevens has said he and Jim Mackey are “entirely open” to health economies dropping payment by results in favour of alternative funding systems for the next two years.

The NHS England chief executive, speaking about the perverse incentives of the payment by results tariff, said areas could choose to move instead to “allocate funding on a programme basis”.

Planning guidance published by NHS England and NHS Improvement last week said groups of organisations will soon receive “whole system” control totals – designed to enable flexibility in financial flows. However, it did not discuss a shift away from payment by results.

Mr Stevens also said the government wants the NHS to “get on with the task” of overhauling services in line with the Five Year Forward View and there is “no new reform plan” for the health service.

South West CCGs seek tie-up

When NHS England pressed the “reset” button in July, it announced that North Somerset and South Gloucestershire CCGs would be placed in “financial special measures” and told to work with Bristol CCG to move towards a “single commissioning leadership structure”.

As NHS management jargon goes, “single commissioning leadership structure” is typically opaque. But a few months on, details have emerged about what it’s likely to mean.

Letters between the CCGs and NHS England obtained by HSJ reveal it will definitely involve the appointment of a single accountable officer.

However, the CCGs confirmed to HSJ that they might go even further and undertake a full merger of the three organisations.

UnitingCare review raises concerns on chaotic process

A critical report of the commissioners and advisers involved in the collapse of the £750m UnitingCare contract is the last national level post mortem on the debacle before new guidelines are set out next month.

The PwC report, commissioned by NHS England, raised concerns about every step of the process, from the budget set by Cambridgeshire and Peterborough Clinical Commissioning Group to how the CCG and its advisers managed it.

The older people’s services contract collapsed just eight months into a five year deal in December 2015.

The report paints a picture of a fragmented approach that resulted in everybody thinking someone else was addressing key issues – like parental guarantees – so they slipped through the sizeable cracks.

NHS England and NHS Improvement are due to set out guidelines next month, which are supposed to be put in safeguards to prevent a repeat of such a pratfall procurement, and have vowed to more actively scrutinise future big ticket contracts.

Organisations fail to respond to NHS Digital’s request

More than a third of organisations that received unauthorised NHS data during the rollout of have failed to respond to NHS Digital’s request to destroy the records, HSJ reported last week.

The news comes as NHS Digital approaches the end of a six month period during which it agreed to remedy the unauthorised sharing of data under the now-defunct scheme.

The organisation has until 19 October to action around 700,000 patient record opt-outs and tell people their confidential data may have been shared against their wishes, as part of an agreement with the Information Commissioner’s Office.