Your essential update on health for the week.

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories 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.

Spend money to save money

NHS England employed external consultants PA Consulting on a £200,000 contract to carry out a ‘function mapping exercise’ – or, in layman’s terms, to tell NHSE what its responsibilities were.

This was done at the start of 2018, ahead of NHSE announcing a closer working relationship with NHS Improvement.

One insider criticised the use of the consultancy firm, arguing NHS England should have the staff and ability to do that work itself, especially given much of its role is set out in legislation under the Health and Social Care Act.

NHSE, however, argues this was a complex issue and the work will contribute to the successful merger, which will ultimately save the taxpayer £100m.

More missed targets

John Appleby from the Nuffield Trust put it best – the performance results data released “looks pretty appalling”.

With the first quarter’s accident and emergency results the lowest ever, record high elective waits and trolley waits, and missed diagnostic targets in the monthly announcement, you can understand where he’s coming from. The think tank chief economist goes as far as to express surprise there doesn’t seem to be any ministerial statement on the ever-declining performance.

Creative accounting

With “control totals” and “provider sustainability funding”, trusts are encouraged to spend time fiddling with their balance sheets to help make the headline numbers look better.

A complex transaction undertaken between University Hospitals of Derby and Burton Foundation Trust and its charity arm was the latest to test the auditors.

It involved the trust selling long-term leases for its buildings to its charity, and then renting them back from the charity on shorter-term deals.

For the charity to afford the £210m premium payment for the long-term leases, it has taken out a loan financing facility with the trust. The charity’s rental income from the short-term leases then funds the interest payments on the loan.

Meanwhile, the “book value” of the assets on the trust’s balance sheet was around half the sale price. So, the trust expected to benefit from a £102m “profit on disposal”, thereby boosting performance against its financial control total, and triggering around £60m of incentive and bonus payments as a reward.

Although the deal went ahead, the accounting treatment that gave rise to the financial boost was ultimately rejected by external auditors, which scuppered the £60m.

Staging an intervention

On many a policy issue, an apparently simple moral standpoint is often not quite what it seems.

So it is with treatments deemed of little or no worth when compared to the risk and cost involved which the NHS has decided it will no longer fund except in extreme circumstances; and where it is determined to radically drive down NHS activity.

If someone wants a lesion removed or trigger finger released, it may rightly not be a priority for NHS resource, but why can’t they pay for it out of their own pocket? And if they can, why shouldn’t NHS private units – which are after all already charging for ops including these ones and have for many decades – carry it out for them? (And they are, as we reported on Monday afternoon). Especially when trusts are under intense pressure to fill financial holes.

But, conversely, allowing this makes the NHS entirely complicit in this inequality of access based on ability to pay, and schemes where hospitals are very likely to link NHS restrictions into their own income generation and private unit marketing.

And, as Academy of Medical Royal Colleges chief executive Alastair Henderson commented on Tuesday on the story, if a treatment does not represent an evidence-based intervention for a patient, why should NHS trusts be offering them privately or otherwise?

This is the thinking of NHSE, along with the academy and other partners, who on Monday staged an intervention over these interventions, warning trusts to follow their earlier guidance and cease.

Bravo to chiefs who spoke their minds

Expressing the view that we live in a divided, more fractious nation is a commonplace, as is bemoaning the fact that this can lead to anger and abuse. What is much rarer is a direct challenge to the discriminatory views endemic in some communities.

So “bravo” to Nick Hulme, Melanie Walker and Andrew Ridley – the chief executives of, respectively, East Suffolk and North Essex FT, Devon Partnership Trust and Central London Community Healthcare Trust.

The three chiefs took the opportunity of appearing at an HSJ roundtable debate with fellow CEOs to declare that NHS leaders had a responsibility to “call out” racist and homophobic communities on behalf of staff and patients alike.

And “bravo” too to new NHS chief people officer Prerana Issar, who backed the chiefs, stating: “Leaders in the NHS are leaders in the country and therefore they definitely have a larger role [in addressing wider societal issues].”


Ian Dalton may have left the NHS for now, but he may yet have an impact from the sidelines with his new job helping the government automate public services.

The government announced that, fresh from his departure from NHSI, Mr Dalton will be redeployed as executive chairman of its new automation taskforce.

In hiring Mr Dalton to the role, Cabinet Office permanent secretary John Manzoni didn’t cite his automation know-how but instead how he “supported the NHS to improve their performance, improving its financial performance and ensuring the NHS is more integrated”.

If automation can help with any of these tasks, then Mr Dalton may yet have a contribution to make to the NHS.