Your essential update on health for the week.

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.

Culling the list

When the global digital exemplar programme was announced, there were complaints it was picking a few winners and leaving the rest of the NHS IT estate behind.

Now, NHS England’s programme of giving a cadre of digitally capable trusts (or “exemplars”) hundreds of millions of pounds to show other trusts how digital is done is itself at risk of being left behind.

Several well-placed sources have said the £200m new wave of “digital exemplar” trusts, promised by the health and social care secretary Matt Hancock in September and scarcely heard of since, is not coming. 

There are now significantly more central tech projects than money to pay for them. HSJ has been told, as the new central tech unit NHSX culls the list, new GDEs are among the most likely to go.

A rarity

A coroner has taken the unusual step of fining a trust chief executive. The £500 penalty issued to the Isle of Wight Trust boss, Maggie Oldham, was for failing to respond to a Schedule 5 notice, which gives coroners the power to compel someone to appear at a hearing or produce documentary evidence.

According to Simon Turner, a partner at law firm Weightmans, such an action is “surprising” because “most coroners and their respective trusts enjoy effective working relationships”.

He continued: “It would be rare in our experience for such a fine to be levied against a trust.”

Banker needed

Primary care networks will get new money from NHS England, for example, to reimburse most of the salaries of their new staff. To take in the cash, the networks need to have one of their members set up to act as a banker.

Some felt their local GP federation would be better placed to handle this. Unfortunately, the rules for PCNs, set out by NHS England in April, complicated this.

HSJ understands NSHE is working with commissioners and partners in primary care to clarify that GP federations can perform the role.

A troubled trio

Norfolk remains special measures country following its latest visit from the Care Quality Commission.

This time it was the turn of its long-troubled tertiary provider Norfolk and Norwich University Hospital Foundation Trust.

The hospital’s overall rating was lifted from “inadequate” to “requires improvement”. But the provider will remain in special measures and ongoing cultural problems in its emergency department continue to blot the copy book.

Norfolk’s mental health provider, Norfolk and Suffolk FT, and one of its two district general hospital providers, Queen Elizabeth Hospital King’s Lynn FT, are also in special measures. This means an unprecedented three providers in the county are in the improvement regime. 

Money for nothing

New British Medical Association guidance has laid out how senior doctors could get a higher pension in return for cutting the number of hours they work.

This quirk in the system is caused by a combination of the annual allowance taper and scheme pays interest.

The former is a widely-reported worry, and concerns have already been raised it could be leading higher earners to cut their hours to avoid being stung by high tax charges. But the BMA pointing out to doctors that dropping back on workload could result in more money for them once they have retired is a newer take on the tale. 

Airing the laundry

Tensions between managers and clinicians are commonplace in any hospital. But when one group starts publicly criticising the other, it suggests a serious breakdown in relationships.

Worryingly, some senior emergency doctors at Lancashire Teaching Hospitals Foundation Trust have done just that, taking to social media to raise concerns over patient safety and criticising executives.

One of the doctors was Stuart Durham, an emergency medicine consultant, who posted on Twitter on Friday: “Absolutely ashamed of our exec! Despite repeated attempts to tell them how bad it is in the ED they don’t understand. We warned them again in a letter today and again they blame us!”

It’s not been an easy last few years for LTHFT, what with a glaring deficit, deteriorating performance, the loss of several senior managers, and plenty of controversy around the fragile accident and emergency department at Chorley.

Helping hand

It is not an easy time for the alliance of eight clinical commissioning groups in north west London.

This month, the alliance released a 2019-20 budget which projects ending the year with an £87m deficit, missing the £21.5m control total by almost £66m.

But, with a little outside help, this gap could close.

The hoped-for help may come in the form of some payback for hosting GP at Hand, which operates out of Hammersmith and Fulham CCG but uses video consultation to attract thousands of patients from outside the area.

The CCG alliance’s finance director told the joint committee this month that “the value of the healthcare provided to these non-north west London patients is just short of £22m”.

The CCGs would like that back, either from the CCGs where the patients originate or from the centre.

Backlogged

When NHS England published the inaugural annual report by its learning disabilities mortality review programme last year, it suffered considerable backlash. Most of the critics objected to how the report had been published – quietly, on a Friday, with no press release – and accused both NHSE and the Department of Health and Social Care of trying to “cover up” the findings.

Despite progress, this year’s report – not yet officially published, but HSJ has seen a leaked copy – shows continued struggles with the LeDeR programme with 38 per cent of deaths still to be allocated to a reviewer and three-quarters of all death reviews yet to be finished.

The way the programme is set up and funded means those carrying out the reviews do so on top of their day job. As a result, the pace at which reviews can be done depends largely on when they can be fitted into somebody’s already-packed schedule.