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

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After the election

We’re always looking ahead at HSJ, well nearly always, and thus we give you two new op-eds considering what life looks like for NHS leaders on the other side of the general election.

Not to preempt anything – the polls are all over the place… a lot of this might look surprisingly similar whether it’s Conservatives or Labour in charge, anyway.

In the first of a new weekly column from our comment editor Andy Cowper, he outlines the huge challenge the health sector faces in getting government to listen to it and take seriously its challenges, chiefly the funding predicament.

Meanwhile, senior bureau chief Dave West argues there is a signficant risk for the NHS of tumbling into another top-down structural reorganisation, the Tories having said they are open to major change in their manifesto.

NHS Improvement’s U-turn over agency tax rules

The latest mea culpa from NHS Improvement, which acknowledges it got its advice wrong over implementation of new agency tax rules. Somewhat curiously it comes two months after the new rule came into force.

NHS Improvement said: “Our priority is to help encourage NHS providers to ensure that agency staff pay the correct tax. Today we have published updated guidance on the IR35 rules, which amends our previous guidance to trusts and ensures that there is no ambiguity in what trusts are expected to do.

“Trusts should not assume that all agency staff will fall inside IR35; they need to assess whether or not the IR35 rules apply on a case by case basis.”

Sustainability’s big winners

HSJ finance correspondent Lawrence Dunhill has carried out a detailed and illuminating analysis, laying bear the impact of the £1.8bn “sustainability” element of the “sustainability and transformation fund” during 2017-18. The NHS financial regime was turned on its head in 2017-18 in a Treasury-driven bid to ensure the provider-side deficit reduced and the system balanced overall.

Huge sums were effectively held back, in the £1.8bn fund and £800m withheld in clinical commissioning group budgets. The £1.8bn was dished out in a fairly ad hoc and translucent fashion. Lawrence’s analysis reveals the trusts which won and lost most; and the areas of the country which were winners and losers too. So much for an evidence and fairness-based allocation formula.

Examining the distribution of the STF shows that while, as intended, it bumped more trusts into surplus, it also apparently had the effect of rewarding trusts which were already in relatively good financial health (not necessarily the aim), and may have rewarded those with better care quality: Contentious since some would prefer to help those in the most trouble / provide equitable high quality healthcare. 

Stretching the patience of patients

Purdah has failed to stop the Care Quality Commission doing its job, with its latest publication revealing details of the annual inpatient survey. Despite the worsening performance of the NHS on key waiting time targets like accident and emergency, referral to treatment times and cancer waits, patients’ experience of the health service is holding up.

When asked about their overall experience of care, results were broadly the same in 2016 as 2015. They were asked to rate it from 0 (very poor experience) to 10 (very good experience). The proportion saying “very good” (10) increased by 1 per cent, while the CQC said the number saying very poor (0) had seen a “significant” increase on 2015, albeit remaining at only 1 per cent. The overall picture on this question was very similar to 2015.

But the report does warn of deteriorating trends which are a concern. The report said: “Whilst longer term trends are positive and indicate overall improvement, there are a substantial number of areas where results have declined in the last year (between 2015 and 2016). This is particularly around patients feeling involved in their care, waiting for a bed on a ward, and care after leaving the hospital.”

NHS England in the dock

NHS England could well save costs by maintaining a regular presence at the High Court. In the past 18 months it has lost a number of judicial review cases focused around its specialised commissioning decisions. HSJ has reported that once again the commissioning body has found itself on the losing side, with two separate decisions against it following a refusal to prescribe a drug to a seven year old boy with a rare genetic condition.

Having first tried and failed to argue that the boy was not an exceptional case, NHS England changed its stance and instead accepted the boy was after all, exceptional. Its new grounds for refusal was that the drug, Kuvan, was not proven to be clinically or cost effective. Lawyers for the family went back to the High Court last week and successfully won permission for a new judicial review against those decisions.

The case could have far reaching consequences. The family’s legal team are arguing that NHS England may have breached its duty under the Children’s Act and human rights legislation. The judicial review will be heard in July.

Mackey reveals next steps to tackle ‘ridiculous’ PFI deals

NHS regulators have set out next steps in their rather long running efforts to help trusts buy out private finance initiative contracts which have “absolutely ridiculous” profit margins.

In a letter sent to providers, NHS Improvement said it was planning an event for providers with “early PFI deals”, to discuss plans for the remaining years of the contracts.

In the NHSI letter, chief executive Jim Mackey said: “I am… grateful for the suggestion of Susan Acott, chief executive of Dartford and Gravesham Trust, that we should bring together those trusts with early PFI deals, to discuss how best to plan for the final years of these contracts and to deal with the specific issues that may arise at this point.

Random checks of non-executive directors’ CVs

NHS Improvement is to introduce random checks of the non-executive directors’ CVs, HSJ can reveal.

Papers presented to the most recent NHS Improvement board meeting show the regulator will start introducing the checks as soon as the purdah period is over.

The news comes after the jailing of the chair of Royal Cornwall Hospitals Trust for lying about his qualifications.

In March Jon Andrewes was given a two year sentence after working in senior NHS non-exec roles for a decade. He falsely claimed to have two PHDs and a Masters, plus a degree from the University of Bristol and a diploma from the Chartered Institute of Management Accountants.