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.
Mid-year progress report for NHS financial plan
Jim Mackey, chief executive of NHS Improvement, said the combined mid-year forecast for trusts will be “around the mid £600m mark”, against the £580m planned deficit.
However, Mr Mackey suggested this may have included overly pessimistic initial forecasts from trusts, and explained that various factors can result in the numbers changing before being formalised.
The year-end forecast includes the entire £1.8bn “sustainability and transformation fund”, which was introduced this year to incentivise trusts to improve their finances.
The combined financial plans for trusts have set a planned deficit of £580m for the year. Last month NHS Improvement and NHS England said actions had been taken to ensure the deficit was “no more” than this, but reiterated the aim to reduce it to £250m.
NHS England loses PrEP appeal
On Thursday, NHS England lost its appeal against the High Court ruling that it has the power to commission the preventative HIV drug PrEP.
NHS England had claimed it couldn’t consider funding PrEP – which involves HIV negative people taking an antiretroviral drug to avoid getting the condition – because it didn’t have the legal power to commission it.
The national commissioner instead argued that responsibility for preventative medicine for sexually transmitted diseases lay with local authorities.
Francis calls for regulation of managers
The architect of the fit and proper person test for board directors in the NHS, Sir Robert Francis, has written for HSJ, casting doubt on the effectiveness of the legislation and suggesting senior NHS managers should be regulated as part of a reformed professional regulatory system.
Sir Robert’s concerns echo criticism of the Care Quality Commission, which has been accused of not effectively enforcing the powers which allow it to remove a director from a board if they are deemed unfit.
The CQC is now reviewing the fit and proper person test, with a report due out next year.
PCS problems continue
One of the most lively conversations on hsj.co.uk this week has been around Capita’s controversial primary care support services contract.
The company has been widely criticised since it took over PCS last September, with widespread reports of services deteriorating after it began centralising services and closing local offices.
In a debate on the contract on Tuesday evening, health minister Nicola Blackwood said that bids for the PCS contract were assessed for quality and cost, and had been scrutinised by the Department of Health and the Treasury – but it is now “evident that Capita were inadequately prepared for delivering this complex transition”.
STP’s capital concerns
Some of the key problems with the STP process have been highlighted in fairly stark terms by health leaders in Cheshire and Merseyside.
A leaked copy of the region’s STP submission to NHS England outlines significant blocks and risks around implementation – chiefly around capital funding, management capacity and an absence of contingency money.
The submission says the plan is “heavily” dependent on capital – totalling more than £750m – but acknowledges there is next to no possibility of this being available.
This of course raises doubt over whether the plan can be implemented in full, and therefore whether the £900m financial gap facing the region by 2021 can be successfully closed.
No proof in this pudding
STPs are already known as “sticky toffee puddings” among some NHS leaders, but a plan leaked to HSJ has been described as “motherhood and apple pie” due to its lack of detail.
The document for the Lancashire and south Cumbria STP says £160m is required over the next two financial years to deliver key changes to NHS services, but largely sets out high level intentions rather than detailed options or proposals.
A senior leader in the region told HSJ decisions around service or organisational mergers have not yet been taken, while another said: “There’s absolutely nothing in the STP. It’s all motherhood and apple pie.”
Acid test for parity of esteem
NHS England has made its first step to meeting the “acid test” of new cash pledged for the mental health sector reaching the front line, but more than a fifth of commissioners have fallen at the first hurdle.
The national body has published a dashboard to show how clinical commissioning groups are faring against various quality and performance indicators, including how much they are investing in mental health.
Analysis by HSJ has found that 46 of the country’s 209 CCGs have failed to raise their mental health budgets from 2015-16 to 2016-17 by the same percentage as their overall allocation increase – which is an NHS England requirement.
Eight of those CCGs failed to raise their mental health budgets at all, effectively cutting their spending in cash terms this year.
Regulator merger predicted
Regulation “might well move” to a single organisation overseeing both quality and finance in the future, the CQC’s chief inspector of hospitals has said.
Sir Mike Richards was responding to a question at an HSJ webinar last week about whether it was still necessary for NHS Improvement and the CQC to exist separately. He said: “I think this is a process of evolution now – whether we will have separate quality and finance regulation in five years’ time, who knows?
“This is where we are and we are making it work and we are making it work effectively. I think it is considerably better that we [now] have two organisations not three [as before NHS Improvement was created] so that is progress.”