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.

Insufficient support systems

The board of United Lincolnshire Hospitals Trust got a ticking off recently, when a non-executive director raised concerns about the high number of doctors in the trust with General Medical Council restrictions

Medical director Neill Hepburn confirmed there were indeed nine locums on the books with GMC restrictions, but he added an agreement was already in place not to take on any new locums with restrictions. Those already hired “would be worked out but consideration would need to be given to fragile services” and the trust would put in place a requirement for all locums to be on the speciality register prior to working at the trust.

But what is interesting is, when HSJ approached the trust for more details, Dr Hepburn said the call was made not only to make “sure our patients are kept safe and have the best experience” but also because the trust “does not have sufficient systems in place to give them the support they require”.

When two become one

The coming together of Taunton and Somerset Foundation Trust and Somerset Partnership FT will create a near unique type of organisation for the NHS.

Somerset FT, as the new trust will be known, will provide a full raft of acute, community and mental health services. Although Isle of Wight Trust currently does this, it’s on a far smaller scale.

But – as HSJ revealed this week – the merger has been delayed by some months. This is unlikely to cause many problems and is most likely a reflection that the initial target of October 2019 was a little too optimistic.

Saving for a rainy day

As of this month, 21 of the 45 NHS organisations in the East of England region are in deficit. Now, the new NHS England and Improvement director, Ann Radmore, wants a reserve fund to support the patch through the next four years.

Ms Radmore wants to take out a touch under 1 per cent from the region’s £11bn annual allocation to build up the risk reserve to cope with any organisations that continue to falter financially over the next four years; to ensure they meet the long-term plan target of having all NHS organisations in financial balance by 2023-24.

She has asked the four sustainability transformation partnerships and two integrated care systems that cover her manor to hold back to build in “additional stretch” to financial plans. This would equate to 0.5 per cent allocations for commissioners and 0.5 per cent of income for providers.

In all, it would add up to an annual reserve of between £85m and £93m to be held “for the next four years to be used to mitigate risk as it arises and to ensure the long-term plan financial commitments can be met”.

The future of Southport and Ormskirk Hospitals Trust and its acute services have been uncertain for several years, with snail-like progress being made to determine its future.

The trust has deep financial problems, while the current clinical configuration is widely deemed unsustainable.

Whether the trust gets acquired by a bigger neighbour, broken up, or somehow struggles along will be a primary consideration for the well-regarded Trish Armstrong-Child, the newly appointed chief executive.

She will be the trust’s seventh chief executive in four years, which includes a succession of interims.

Written equivalent of a shoulder shrug

The rules surrounding NHS pensions can be pretty prescriptive, with contribution rates, tax relief allowances and administration levies all out of trusts’ hands.

Which is perhaps why the Department of Health and Social Care’s written equivalent of a shoulder shrug on what to do with unused employers’ pension contributions if a doctor chooses to reduce the amount they are contributing to their pension – one of the proposals in its recently published consultation – has been described to HSJ as “significant”

The document read: “Employers have the discretion to pay to the member unused employer contributions in these circumstances, although this would be a decision for individual employers.”

There can be only one-ish

One thing which has arguably marked out the integrated care system policy in recent years has been its flexibility and ambiguity. That has suited those involved – the project has stayed away from too much restructure-obsession, and avoided falling into the pitfalls of controversy or competition which have dogged attempts to create “integrated care providers” or “multispecialty community providers”.

But ICSs do have more bureaucratic reasons for their place on this Earth, and that is to make the current NHS structure simpler, with a much greater degree of clear regional strategic planning.

In many people’s minds, this requires stripping back some of the other layers of structure. Clinical commissioning groups – of which there are 191 at the moment – are normally the favourite target, with a lot of people imagining there will soon be one per ICS.

Yet the cookie cutter is never going to work for everyone. The objection especially comes from systems which are large and have more than one strong locality, with strong identities, personalities and often their own top-tier local authorities, underneath them. These include ICSs like the Greater Manchester devolution project and West Yorkshire and Harrogate, which are often held up as exemplars. 

In the end NHS England will not want to overrule GM, Yorkshire and others in this position. So un-“typical” systems – and a commissioner landscape numbering well over 50 – might live on for some time.