Your essential update on the week in health

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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Trusts will miss deficit target

The admission that NHS trusts were going to miss their financial plan for 2016-17 was always going to come, so perhaps it’s a victory of sorts that it’s taken until February.

Research by HSJ has revealed that providers have indicated a year-end deficit approaching £1bn to NHS Improvement, following a deterioration of around £280m over the last few months.

This would significantly breach the maximum £580m deficit “control total” set by national leaders, although it is understood the regulator has since managed to improve a number of the forecasts following discussions with trust boards.

For the first time in public at least, Jim Mackey, the NHSI chief executive, has admitted the £580m control total will not be met.

The aim of the game will now be to stay within the £800m risk reserve that CCGs have been forced to hold back from their allocations.

Achieving this will require significant one-off transactions to boost income, however, as well as the bulk of providers’ backloaded savings plans coming close to delivering in full.

NHS’s top chief executives 2017

HSJ has published its annual analysis of the top trust chief executives in the NHS – and there have been changes at the top, and significant new trends have emerged.

Three key themes are: how the top leaders are increasingly running more than one organisation; how influential Care Quality Commission ratings have become; and how women may soon come to dominate the top ranks of the provider sector.

Jeremy Hunt told HSJ in September 2015 that CQC ratings had replaced foundation trust status as the “definition of success” for NHS trusts, which appears to have come to pass. Five of the 10 trusts awarded an outstanding rating now see their chief executive among the top 15, with three within the top five.

CCG shake-ups revealed

Last week HSJ reported that the three year freeze on CCG mergers could be coming to an end, and a wave of consolidation could be on the cards.

Aylesbury Vale and Chiltern CCGs, both in Buckinghamshire, have applied to NHS England to merge at the beginning of 2017-18 – but this is yet to be formally considered and approved.

We revealed on Tuesday that five north London CCGs have appointed a single chief officer to cover their entire Sustainability and Transformation Plan footprint.

Last year Simon Stevens used the north central London STP footprint as an example of an area that could adopt the “NHS equivalent of combined authorities”. Mr Stevens said the grouping could span hospitals and commissioners, and consolidate CCGs.

We also reported that Bristol, South Gloucestershire and North Somerset CCGs have recruited a joint chief officer – Julie Ross, chief officer of North West Surrey CCG and the lead for Surrey Heartlands STP will take up the role in June.

Trusts chosen for new Carter review

After Lord Carter said last week that the clinicians – not management consultants – should lead the NHS’s efficiency drive, HSJ has revealed details of his next productivity review.

Twenty-three mental health and community services trusts have been chosen to take part in the investigation into efficiency in the sector.

The project will follow a similar structure and methodology to Lord Carter’s previous investigation into acute hospital productivity, a letter from NHS Improvement says.

The 23 providers will begin six months of detailed engagement in the first phase of the review, with Lord Carter and a team from NHSI’s operational productivity directorate.

NHSI and the Care Quality Commission are still carrying out a public consultation on how they will jointly assess and rate “use of resources” by trusts.

HSJ reported on Tuesday that patient groups have warned that providers would be “at risk of overlooking quality and safety” under proposed changes to the CQC rating regime.

Sir Robert Francis: NHS facing ‘existential crisis’

This month marks the four years since the publication of the Mid Staffordshire public inquiry, and its chair, Sir Robert Francis QC, delivered a stinging rebuke to health secretary Jeremy Hunt and the NHS’s most senior figures in an interview with HSJ.

Sir Robert, a non-executive director at the Care Quality Commission, said the NHS was facing an “existential crisis” and that “depressingly familiar” pressure on NHS chief executives meant it was “inevitable” that mistakes that led to the Mid Staffordshire scandal would happen again.

He warned that the measures in the Five Year Forward View and sustainability and transformation plans (more of which below) were “unrealistic” and a “make do and mend” attitude was “neglecting adult social care”.