HSJ Catchup: Bumper week for special measures and flagship cancer contract dropped

Four trusts placed in special measures

It has been a busy few days for the Care Quality Commission, with four trusts entering special measures in a week.

Two were first timers – Kettering General Hospital Foundation Trust, which HSJ had previously reported was in trouble, and the Isle of Wight Trust.

Two were original Keogh trusts re-entering special measures: United Lincolnshire Hospitals Trust and Northern Lincolnshire and Goole Hospitals FT. Both are in central and north Lincolnshire, suggesting that the struggling providers may not just be dealing with poor leadership or beleaguered staff, but systemic issues specific to the local health economy.

While the CQC is adamant that there is no special measures quota or limit, there appeared to be a clearing of the decks at the start of the year. Five trusts between January and March left special measures, one of which, East Kent Hospitals University FT, was cleared for exit by the CQC in December but unusually there was a three month delay in ratifying the decision by NHS Improvement.

The NHS starts the 2017-18 with 15 trusts in special measures, and although different trusts have entered and exited, it started 2016-17 with 16 trusts the programme.

’Toughest year yet’ for finances

“2017-18 will be the toughest year yet for the NHS and NUH,” so says Nottingham University Hospitals Trust’s deputy finance director.

In a message to staff, seen by HSJ, NUH chief executive Peter Homa had said the £930m-turnover trust was facing its “toughest financial challenge ever”. 

Another illustration of the challenge facing trusts comes from the South West: Plymouth Hospitals Trust plans to save £40m in 2017-18 – nearly 10 per cent of its income, and nearly three times the £14m the trust saved in 2016-17.

Lord Carter, who led a major review into NHS efficiency, and former Monitor chief executive David Bennett have previously said 2 per cent is an achievable efficiency target for providers.

HSJ’s finance expert says the trusts has “no chance” of achieving its savings plan.

Meanwhile, Burton Hospitals FT says it risks missing its 2016-17 control total because it’s been unable to sign a subcontract with Virgin Care. The deal has been held up until the private provider and East Staffordshire CCG resolve a contract dispute.

£687m contract tender dropped

A controversial tender for cancer services in Staffordshire worth £687m has been abandoned after a consortium led by a private provider failed to convince commissioners its offer was financially viable.

Only one bidder, a consortium led by Interserve, remained in the running for the contract. The consortium also included University Hospitals North Midlands and The Royal Wolverhampton trusts.

The tender process for the 10 year, prime provider contract had been running since 2013 and HSJ understands the procurement has cost the four Staffordshire CCGs more than £840,000.

The decision by commissioners not to award the contract on financial grounds follows the high profile collapse of the £800m UnitingCare Partnership contract, which was abandoned in December 2015 eight months after going live.

As a result, procurement of the Staffordshire cancer contract and a separate £535m end of life care contract were paused for several months while a review was carried out. The process resumed in November.

CCGs warned over financial moves

NHS England has warned CCGs that offer providers extra income to deliver their financial targets – and therefore trigger their Sustainability and Transformation Fund payments – could be “personally” scrutinised by national officials.

Under the STF rules, trusts that meet or exceed their surplus or deficit target qualify for increased incentive payments. Some CCGs appear to be considering whether securing this funding for the health economy should take priority over meeting their own financial target. The extra income paid to trusts for 2016-17 could then be returned to the CCG in 2017-18.

When asked if it was comfortable with these offers being made, a spokesman for NHS England said: “Individual CCGs need to honour their agreed year-end financial delivery commitments, which are critical to securing the overall NHS financial position.

“Therefore any substantial last minute adverse movement by a CCG – whether or not related to the STF – will be subject to external review by auditors appointed by NHS England plus national scrutiny involving the CCG’s audit committee chair, finance director and accountable officer personally.”

This appears to contrast with the view taken by Jim Mackey, chief executive of NHS Improvement, who told HSJ in an interview last week that the discussions could be appropriate.

More CCG consolidation in the North West

Four CCGs in the North West plan to establish a “unified health commissioner” that could lead to a formal merger of the organisations.

The accountable officers for West Cheshire, South Cheshire, Vale Royal and Eastern Cheshire CCGs have agreed a joint committee should be created as a first step, with their governing bodies being asked to approve the plans this month.

These are the latest CCGs in the region looking to merge or create shared leadership committees, following groups in Manchester and Merseyside.

The plans were explained in a public board paper for South Cheshire and Vale Royal CCGs, which said the county’s current commissioning arrangements “often resulted in delays in decision making” and “variation in decisions and approach taken”.

However, the document adds: “Any decision to merge the CCGs must be taken and led by the GP membership of each CCG.”

South Cheshire and Vale Royal CCGs already share an accountable officer, Simon Whitehouse, and have had merger ambitions since 2015.