HSJ Catchup: Data clash, A&E pressure hits finances, and STP taskforce

Clash over data

Last week, HSJ reported that NHS Digital and the Home Office have signed an agreement allowing confidential patient information to be shared to trace suspected illegal immigrants.

But on Wednesday, former NHS Digital chair Kingsley Manning revealed that patient data, similar to the information now being shared under the agreement, had been passed on to the Home Office since “at least” 2005.

He said he repeatedly challenged the Home Office under Theresa May over the legality of sharing confidential patient information to find illegal immigrants.

Mr Manning, who was chair from 2013 to 2016, said: “We said to the Home Office: ‘We need to understand what the legal basis of this is.’ The Home Office response was: ‘How dare you even question our right to this information. This is data that belongs to the public. It is paid for by the taxpayer. We should use it for public policy’.”

He said that when he launched a review to establish a clear legal framework for the data sharing there was an “enormous reluctance from both the Home Office and the Department of Health to clarify any element of this process”.

A joint statement issued by the Home Office, the DH and NHS Digital responded: “We are absolutely committed to transparency and robust legal frameworks relating to data sharing… The new memorandum of understanding which we have openly published makes it clear that no clinical information will be shared.”

Pressure pile-up on emergency services

Extra strain on emergency services in recent weeks has led to “significant additional and unplanned financial pressure” on NHS trusts, NHS Improvement has warned.

In a letter to trust leaders last week, NHSI said many providers have found ways to address the financial pressures, often with support from commissioners. But other trusts have “more work to do”.

Many providers will have been forced to deploy additional agency and bank staff in recent weeks in order to cope with increased activity levels in non-elective services.

It is therefore likely that for many trusts, unplanned expenditure has made their year-end financial targets even harder to meet. It is not yet clear how much unplanned expenditure there has been.

Winter pressure points

Just 10 hospital trusts have been responsible for more than a quarter of the “winter pressures” alerts issued since 1 December, HSJ analysis reveals.

The trusts with the highest number of level three or four “OPEL” alerts were Isle of Wight Trust and Royal Berkshire Foundation Trust – both with 24 between 1 December and 20 January.

• Explore the data

The DH debt mountain

The word “fantasy” often crops up in discussions about STPs’ financial plans, even before we remember that dozens of NHS trusts will have to repay more than £2bn of bailout loans drawn down from the DH.

Analysis by HSJ has revealed which STPs will face the largest mountain of debt.

It seems unlikely that organisations such as North Cumbria University Hospitals FT, or Medway FT, will ever be able to repay their revenue loans.

These two trusts already have debts amounting to more than 30 per cent of their annual income, which are likely to keep on growing for several years until they move out of budget deficit.

There are many more trusts with smaller debts, which in all likelihood are just as unaffordable.

The Sustainability and Transformation Plan process is designed to encourage closer collaboration between local providers, as well as commissioners, with the long term aim of moving towards a shared financial performance target.

So tough luck, it seems, to the apparently high performing community and mental health trusts which have a debt-laden acute provider next door.

In reality, many of these debts are likely to be written off by the DH, but this is unlikely to happen quickly, so trusts having STPs will still have to budget for repayments in the short to medium term.

Will you get a visit from the taskforce?

A new taskforce has been set up to challenge weak workforce proposals in STPs, HSJ reported on Tuesday.

The team, made up of senior nursing figures from arm’s length bodies including NHS Improvement and NHS England, has been set up to examine, and where necessary challenge, STPs’ workforce plans.

The group started its work last month. It is unclear which STPs are being looked at and whether the team has achieved any changes to the plans.

Ruth May, NHS Improvement’s director of nursing, said she was worried about what she called a “divergence” away from trusts’ operational plans, and forecasts of large reductions in nursing staff in some STPs.

She said workforce plans were the “weakest” parts of the STP process, adding the plans had a long way to go to demonstrate they would have sufficient staff to maintain patient care.

In an interview with HSJ, Ms May also said: “I personally need to step up my efforts to think about what we can do nationally to increase the amount of nurses that we have got.”