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.

Disincentivising the obsolete

NHS leaders are proposing to cut the payments made to hospitals for traditional outpatient appointments, HSJ understands.

An engagement document for the national tariff payment system, expected to be published imminently by NHS Improvement and NHS England, will put forward changes that incentivise providers to transform their traditional outpatient models.

Senior sources said the changes are likely to be geared at reducing the number of consultant led appointments and encouraging hospitals to conduct more appointments remotely.

Earlier this month, Ian Dalton and Simon Stevens, the respective chief executives of NHS Improvement and NHS England, had spoken of the need to transform outpatient services routinely operating under an “obsolete” model.

The next “payment by results” tariff, the mechanism through which providers are paid according to the volumes of activity they carry out, would cover a two year period from 2019-20. An engagement period with local leaders will be followed by a formal consultation.

May the force be with you

It sounds like an almighty row could be brewing over the contentious “market forces factor”.

HSJ understands that the engagement document for the national payment tariff is also set to introduce a long overdue update to the market forces factor, which is a mechanism within the tariff that takes account of cost variations in different geographies, and has not been updated for several years.

Critics have long complained that the MFF is overly favourable to larger teaching trusts in London, which provide specialised services, so any changes are likely to cause a stir among some influential people.

Meanwhile, following on from Simon Stevens calling out the “obsolete” service model for outpatients still widely used across the NHS, the engagement document is also expected to propose cutting payments made to hospitals for traditional consultant led outpatient appointments.

Getting Leathered

Devon’s struggling health economy has appointed another high profile Dame to chair its sustainability and transformation partnership.

Dame Suzi Leather will start in the role this summer and oversee the appointment of a new accountable officer for the STP and its two clinical commissioning groups; Northern, Eastern and Western Devon CCG; and South Devon and Torbay CCG.

The independent chair role was previously held by Dame Ruth Carnall.

Dame Suzi has previously chaired numerous non-departmental government bodies - including the Charity Commission and Human Fertilisation and Embryology Authority – winning her the enviable epithet of “quango queen” from several of our lovely tabloids.

There is still quite a job to do in Devon, despite significant improvement to the financial position being made since most of the county was placed in NHS England’s Orwellian sounding “success regime”.

The organisations within the wider STP ended 2017-18 with a combined deficit of more than £60m.

Capital ambitions

The health secretary’s top property adviser’s warning that the NHS must not waste extra funding on maintaining “decrepit old buildings” comes with huge decisions to be made around the health service’s capital ambitions.

NHS estates tsar Sir Robert Naylor told an audience at the Health Plus Care show in London yesterday that it was crucial the NHS avoid repeating the spending mistakes of the New Labour years.

“What we need to ensure is that we don’t make the same mistakes that we made during the Blair government and simply pour that money into increasing salaries of staff or into new nice things to do or have,” he said.

“Blair’s government wanted money for reform and that’s got to be the mantra for this government as well but we’ve got to use this money in a much more efficient and effective way.”

The prime minister’s £20bn five year funding announcement this month has given system leaders a modicum of certainty about what they have to play with in terms of revenue. But, while there has been much talk of a 10 year capital plan, there is yet to be any substance.

The decrepit, old buildings Sir Robert talks of are commonplace across the NHS, as years of neglect and questionable capital to revenue transfers by the Department of Health and Social Care have caught up on the NHS’s crumbling estate.

The government’s long term capital plan must be radical and genuinely transformative to address this. It cannot simply be a patch up job of a tired, dilapidated estate not fit for purpose for practicing 21st century medicine.

Heart in the right place

Hospital leaders in Leicester have been hurriedly getting their ducks in a row to ensure that children’s heart surgery is not decommissioned by NHS England.

Until the end of last year, the congenital heart disease service at Glenfield Hospital looked set to be closed along with units in London and Newcastle – a threat which still hangs over the services if tougher commissioning standards are not met on time.

University of Leicester Hospitals Trust has now moved to relocate the service into the main Royal Infirmary site, where all its other children’s services are based.

Chief executive John Adler says the relocation is part of the trust’s major reconfiguration programme to create a standalone Leicester Children’s Hospital, and it will be the first time all the children’s services have been under one roof.

The trust is working against the clock to make the move by March 2020, however, which is the deadline set by NHS England to meet its new standards, as it will need to raise an additional £10.5m to pay for the relocation.

Gloom time

Ramsay Health Care UK is one of the biggest private providers of NHS-funded care and their recent stock market notification of financial difficulties is significant.

With the total elective waiting list topping 4.1 million you might expect it to be a boom time for private operators, but Ramsay says that commissioner run demand management schemes (screening out and delaying procedures) had contributed to a gloomy trading position.

The independent sector has come under significant attack from the Care Quality Commission and Jeremy Hunt of late over quality issues.