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.

If someone forwarded you this email you can sign up for your own copy here.

Crunching the numbers on STPs

In a series of stories, HSJ has examined the NHS’s unpublished proposals for dealing with the extreme funding pressure it faces in coming years. Our findings suggest it will employ thousands fewer nurses and other staff in the next few years, and treat tens of thousands fewer emergency patients in hospital.

The analysis is based on the detailed finance, workforce and efficiency plans submitted as part of the sustainability and transformation plan process. These templates have not been published, but HSJ has looked at a sample covering 11 of the 44 STPs, shared on the basis they are not identified.

However, it won’t escape anyone’s notice that reducing emergency admissions, at least in a single year straight off the current trajectory, is not very likely. Many people will say reducing the workforce and controlling acute spending growth (another theme) is unlikely too.

Confidence in STPs’ progress generally is low, some numbers in the templates have already been set aside in the 2017-19 contracting round, and national leaders have distanced themselves from some of the forecasts they’ve been sent.

Simon Stevens pre-emptively poured cold water on our story in last week’s triumphant Commons public accounts committee outing: “Some of the staffing projections within individual STPs will now need to be refined. To nip one potential future controversy in the bud… Anybody who looks at some kind of Excel spreadsheet and infers, ‘oh blimey, there is about to be big reduction’ is wrong.”

So why take any notice of these numbers?

Well, they are the only attempt we have and give us a useful insight about the direction the service will seek to take. Those drawing up STPs have said it is useful to compare them – it’s a shame NHS England has not made fuller figures available. The templates are a clear reminder of some of the ugly choices and trade-offs the NHS faces as it goes through three years of historically low funding growth from 2017-18.

Trusts reject financial targets

Sources have told HSJ around 60 out of 238 NHS trusts have yet to agree their financial “control total” for 2017-18.

NHS providers have again been asked to deliver efficiency savings of around 4 per cent in 2017-18, which has led to a significant number rejecting their target.

Last week, NHS Improvement chief executive Jim Mackey told MPs that trusts would be required to deliver average efficiency savings of 4 per cent next year, which matches the requirement for 2016-17. He has previously called for trusts to be given more realistic savings targets.

Trusts that do not agree their target are not eligible to receive a share of the £1.8bn sustainability and transformation fund. The proportion rejecting their control total is roughly in line with those that initially rejected their target for the current year.

Cost cutting in Whitehall

More than 500 civil servants working for the Department of Health are to leave their jobs under a major Whitehall cost cutting drive, HSJ has learned.

In total 538 employees at the DH are to take voluntary redundancy during the next few months under measures announced following the spending review in 2015, when it was reported that up to 650 jobs could go.

The department is trying to reduce its running costs by 30 per cent over five years, and it is planning to relocate staff from its three existing offices to new premises at 39 Victoria Street in central London.

STPs may need to be ‘estates led’

In an ideal world, sustainability and transformation plans would be driven by clinicians, designing the best possible model of care.

But in reality, some of the STPs will need to be “estates led”, due to horrendously high backlogs of maintenance problems on many hospital sites.

Much of the NHS’s secondary estate is unfit for purpose and unsuitable for further investment, and HSJ has mapped those health economies with the worst problems.

Paul Fenton, chair of the Health Estates and Facilities Management Association and estates director at Ipswich Hospital Trust, is concerned that continuing demand pressures, which have seen dozens of trusts report operational problems in the last fortnight, will “hinder the ability to redesign the estate to enable the shift of care out of hospital due to the need to continue to deliver in the here and now”.

MP wants answers to chief’s extended leave

Mystery still surrounds the extended leave being taken by Sir Leonard Fenwick, the long serving chief of Newcastle upon Tyne Hospitals Foundation Trust.

Sir Leonard suddenly went on extended leave last week, with business and development director Louise Robson and medical director Andrew Welch acting up in his absence. Statements from the trut and NHS Improvement did not say why Sir Leonard had gone on leave, nor if or when he will return.

Now Nick Brown, MP for Newcastle upn Tyne East who has known Sir Leonard for around 40 years, has called on the trust to be more transparent and give a “reasonable explanation” for the current state of affairs.