HSJ Catch Up: Worsening weekend access and sliding deficits

Seven day controversy

Patients are not getting the access to consultants that is expected under the key requirements of the national “seven day” standards, the latest data from NHS England shows.

Less than a quarter of patients see a consultant within 14 hours of admission – even on weekdays.

Another one of the four key seven day standards set out by national leaders is receiving ongoing review by a medical consultant. The data revealed a very large gap between hospitals being able to meet this standard on weekends compared to weekdays. Almost 91 per cent of patients see a consultant regularly during weekdays – but the figure is 69.7 per cent at weekends.

The rollout of seven day hospital services has been a priority for government and is part of its mandate to the NHS. In contrast, NHS England’s response to the data has been a lot less vocal.

Acute trusts are meant to be 100 per cent compliant with the four key seven day standards by 2020 (the other two are around diagnostics and access to some treatments) but it is not clear if NHS England is worried about progress or the challenges that trusts face meeting them.

An academic study earlier this month added to concerns over whether the standards will actually improve care quality. It found access to consultants and diagnostics over the weekends has “no association with weekend death rates”. One of the researchers, Professor Matt Sutton, said: “Implementation of these standards is unlikely to result in any direct harm to patients, but the policy may divert care away from the patients who need it most.”

Don’t expect the controversy around seven day services to die down any time soon.

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The numbers behind the waiting list

Last week, Simon Stevens warned the NHS Providers conference: “On the current funding outlook, the NHS waiting list will rise to 5 million people by 2021… the government would have to publicly, legally abolish patients’ national waiting times guarantees.”

Waiting times expert Rob Findlay has calculated how much it would cost the government to get 18 week waits back on track. He says: “In short, the government has a choice: constrain the money and abandon the right to treatment within 18 weeks, or cough up and honour it.”

The abridged version is: “With some guesses about the costs per case, I calculate recovering 18 weeks sustainably might cost £2.1bn next year and £350m the year after, if other pressures and enough mainstream capacity are funded. Or £4.2bn next year and £1bn the year after, if austerity continues.”

Read his unrivalled analysis to see how he got to these figures.

• More analysis: Sharp fall in elective admission rate

Cash crisis continues

The year end deficit projection for the NHS provider sector has worsened by more than a quarter, NHS Improvement’s latest figures reveal.

The regulator this afternoon released the results for quarter two of 2017-18, which saw the predicted year end deficit for providers worsen from £496m to £623m. The figure is after the impact of bailouts from the sustainability and transformation fund.

The decline was driven largely by the hospital sector, which is predicting an overall deficit of £1.34bn, increasing from £1bn predicted at the start of the year.

NHSI’s activity report said the drivers of the deficit position were “delays or failures” to achieve efficiency savings, cancellations of non-elective work in the face of emergency pressures and agency staffing. Non-pay overspending included education, training and research plus inflationary cost pressures.

HSJ revealed on the same day the lengths trusts are going to in delaying payments to suppliers.

‘One stop shop’ or a waste of time?

NHS England is developing a new framework for technology, this time targeted at sustainability and transformation partnerships and accountable care systems.

It is early days, but signs are the framework could be important for suppliers wanting to sell to emerging local health systems.

For one, NHS England has shoehorned in several existing national “digital” programmes into the framework, most notably the global digital exemplars.

The exemplar programme has, in theory, both central funding (though most of this remains ethereal) and central leadership buy in.

While far more modestly funded and less centrally controlled, it is the closest thing the NHS has to a new National Programme for IT.

That alone would make the framework of interest.

But the scope appears far wider than selling tech products to local health economies, covering a wide range of what is essentially consultancy work on everything from workforce to care pathways.

NHS England believes this “one stop shop” will make it faster, cheaper, and safer for health economies to find partners in their journey towards a brave new world of joined-up accountable care.

But not everyone is convinced, with one supplier calling it a waste of time.

Arbitration results revealed

NHS England has released details of three arbitration cases between commissioners and trusts in disagreement over millions of pounds.

The documents, obtained by HSJ, show:

• Brighton and Sussex University Hospitals Trust won a £6m dispute with NHS England over savings the national commissioning body was demanding on a specialist contract.
• Mid Yorkshire Hospitals Trust won £8m from two clinical commissioning groups over transitional support and legacy costs.
• Sandwell and West Birmingham CCG won its dispute with a local provider over contributing to rebuilding a hospital and invoicing for community services.

In July, HSJ reported the outcome of the £6m dispute between BSUH and NHS England, which NHS England had tried to keep secret.

Big spenders

Commissioners in north west London spent £36m on consultancy firms over the last four financial years – including millions on service redesign recently stalled by NHS Improvement.

North west London, which has been working on a major reconfiguration of services since 2011, spent more than £16m with McKinsey and McKinsey led projects in the four years up to the end of 2016-17, CCG data reveals.

Of the money spent with McKinsey, £9m was on the whole system integrated care programme.