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.

Overseas help wanted

With 42,000 nursing vacancies in the English NHS, a five year timeline for remedying this could be described, diplomatically, as ambitious. 

NHS Improvement chief executive Ian Dalton told a room of NHS chairs and chief executives the shortfall of nurses will be harder to solve than the 11,000 gap in the medical workforce. He emphasised international recruitment, return to practice and improved retention rates.

The desperate need for more international nursing recruits also seems at odds with the Home Office’s immigration white paper, and broader hostile government immigration policy.

Deaf ears

Proposals for a new national medical examiner service have been slow in development. Legislation was passed in 2009 but no action has been taken since.

The Department of Health and Social Care eventually announced plans to go ahead with a watered down scheme from April next year.

But the chief coroner for England has spoken out in his annual report that this reduced service will not actually tackle the gaps serial killer GP Harold Shipman exploited because initially it will focus only on acute care deaths.

Judge Mark Lucraft QC will be forgiven for thinking his report will fall on deaf ears – over a year ago, he warned about a gap in the law that meant doctors were under no obligation to report deaths to coroners, a shortage of pathologists, and the need for new national structures and funding to support coroners and to deliver consistency.

Since that report, the government has done nothing to address the issues Judge Lucraft correctly highlighted.

Too big or too small

The mental health sector in some respects moves quicker than others. While there’s a drive to integrate general services locally (bringing mental health into general practice and liaison with emergency care for example); specialisation is another reality.

In an exclusive interview with HSJ, Joe Rafferty, of Mersey Care – a large mental health foundation trust also providing physical community health – indicated that small trusts risked being swept aside in system integration plans.

Unfit and proper

The Care Quality Commission has come in for a drubbing from a seemingly emboldened rival watchdog, the Parliamentary and Health Ombudsman.

Its report said the CQC’s mistakes in the case of Paula Vasco-Knight were so “fundamental” that it raised the possibility of wider failings and “questions the ability of the CQC to provide robust and appropriate” application of the FPPR rules.

Ms Vasco-Knight was in 2014 heavily criticised by an employment tribunal for the dismissal of two whistleblowers who complained about her helping to appoint her daughter’s boyfriend to a role at Torbay and South Devon Healthcare Trust, which she led.

Despite the criticism, Ms Vasco-Knight was appointed in 2015 as interim chief operating officer at St George’s University Hospitals FT in London, and then briefly as its chief executive before being dismissed when separate allegations of fraud were made to police.

CQC chief Ian Trenholm pointed out that the FPPR system was already in line for reform, but questioned elements of the PHO’s judgement.

The cost of extra support

When University Hospitals of North Midlands Trust went into financial special measures in March 2017, the provider said it very much welcomed the extra support it would receive from NHS Improvement.

Almost two years down the line, the trust now claims it has racked up £19m in costs due to the regulator’s national financial regime.

In an email seen by HSJ the trust has broken down what it sees as the true costs of the financial regime, outlining the impact rules around trust control totals have had.

Trouble in the valley

Wye Valley Trust has long faced struggles typical of a small isolated rural hospital, even though there have been signs of improvement in recent years.

These pressures are now straining the trust’s relationship with Herefordshire Clinical Commissioning Group, which holds a block contract for the majority of its activity.

The trust has argued that, given the rise in activity in excess of the assumption made in that contract, the CCG needs to contribute more to ease the load.

After the CCG’s initial offer of extra funding was rejected, the trust said it was reverting to activity based payment by results terms, and sending the CCG the full bill – which the CCG says it will not pay.

In a counter move, the CCG is also now challenging a broader slew of payments to the trust and has said it will commission another provider to clear Wye Valley’s elective backlog.

The dispute has been escalated to national regulators (NHS England and NHS Improvement) and has yet to be resolved.

Bowing to pressure

Commissioners in Derbyshire have backtracked on their controversial proposals to decommission a service for people with severe mental health needs, following strong pushback from the public and local politicians.

When HSJ first reported on the four Derbyshire CCGs plans to decommission their psychodynamic therapy service as part of a wider cost savings plan, the local branch of Unite union warned the commissioners were “leaving patients with nowhere else to go”.

After months of public and political outcry, the CCGs – which have some serious financial problems on their plate – have decided to stop the consultation to decommission the service. Instead, they will be reviewing all psychological therapies offered across the region.

Location, location, location

The Kent and Medway stroke reconfiguration has been a long time in gestation – it started in 2014 – but a decision on where to site three combined hyperacute and acute stroke units is expected early next year.

A decision by the joint committee of CCGs in late January is unlikely to be the end of the tale, however.

The immediate danger is opposition from within the joint health overview and scrutiny committee set up by Medway Council and Kent County Council, with representatives from Bexley Council and East Sussex County Council also taking part.