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.

Accounting adjustments

NHS Improvement has always tried to put a positive spin on the provider deficit, but is now far more ready to acknowledge the underlying difficulties.

The official reported deficit for 2018-19 was £571m – a significant improvement on the previous year’s shortfall of £966m.

But this was largely thanks to a hugely beneficial accounting adjustment of £256m relating to two private finance initiative hospitals that were brought on to the government’s books following the collapse of Carillion. It also benefitted from more than £1bn of non-recurrent savings.

Meanwhile, the underlying deficit (stripping out one-off benefits) continues to deteriorate, with the report saying it has grown to £5bn from £4.3bn at the end of 2017-18.

Not splashing the cash

NHS providers have, once again, received tens of millions less than promised to improve their IT, HSJ revealed.

Figures disclosed by NHS Digital have shown that in two of the biggest priority areas for NHS IT – digitising providers and improving cyber security – nearly £100m less was spent than planned in 2018-19.

For NHS providers, it is the third year running that the centre has spent less than promised on helping them improve their IT.

It also appears that, after a boost in cyber security funding in 2017-18 following the WannaCry attack, spending slumped £22.9m last year, £34.3m less than budgeted.

NSH England said NHS Digital’s figures don’t account for all central digital spending and the money that didn’t quite make it to trusts to improve cyber security or IT last year will be rolled over to this year.

The £14m thread

Navigating safe passage through the labyrinth of VAT is a tricky business.

But, like Theseus following Ariadne’s thread, health chiefs in the north east have emerged from the maze triumphantly.

Northumbria Healthcare Foundation Trust, rated “outstanding” by the Care Quality Commission, is set to reclaim up to £14m from Her Majesty’s Revenue and Customs after winning a judicial review.

The trust brought the case to the high court after HMRC dismissed an application to reclaim the money over a car leasing scheme run under the name NHS Fleet Solutions.

Anyone with a strong interest in the minutiae of VAT regulations can read the 13-page judgment in its entirety here.

Sensing a theme

Matthew Leahy and Mr R, as he is known in a recent Parliamentary and Health Service Ombudsman report, had a lot in common.

Both men were admitted to the former North Essex University Partnership Trust’s Linden Centre in Chelmsford. Both died – Matthew in 2012, after staff found him hanging in his room, while Mr R “killed himself” in 2008, according to a coroner’s report cited in the PHSO’s review. Both, according to the watchdog, suffered from similar shortcomings in their care, including failures to properly assess and manage risk, and failures to update care and treatment plans.

Just last week, Daily Insight lamented the long line of recent news stories involving mental health services which all seem similarly themed.

Teething problems?

HSJ has published a lengthy investigation into the operation of the new Healthcare Safety Investigation Branch, including concerns raised by multiple whistleblowers.

These insiders, who were all united in the view that HSIB was designed to do important work, spoke out about what they believed was a poor culture and governance at the fledgling watchdog.

To its credit, HSIB hasn’t ducked the issues. Chief investigator Keith Conradi gave a detailed interview to HSJ in which he accepted the organisation had made some mistakes.

HSIB is now a maternity investigation body, that does some national investigations on the side. It is at risk of being diverted from its original aims.

Blast from the past

Junior doctors are “losing faith” in a system used to monitor their workload, with new data suggesting only a fraction of their concerns are leading to changes to services or rosters, HSJ has reported.

The system of “exception reporting” was introduced after the junior doctors’ strike in 2015-16, allowing a medic to file a report when they work beyond their contracted hours, or without a break, as well as other contract breaches.

But data now obtained by the Hospital Consultants and Specialist Association through a freedom of information request suggested there is huge variation in how trusts respond to these reports, with less than 3 per cent leading to service or rostering changes.

Meanwhile – in another reminder of the 2015-16 antics – the BMA and the government/NHS Employers have finally nearly settled on a deal, which will now go to BMA members for a vote. 

Notable names

Congratulations are in order for the 1,073 awarded in the Queen’s birthday honours this weekend. Names HSJ readers might recognise among them include:

  • Stephen Eames, the chief executive of North Cumbria University Hospitals Trust and Cumbria Partnership Foundation Trust has got a CBE. He has also recently been appointed part-time chair at the struggling Humber, Coast and Vale Health and Care Partnership. Professor Eames joined North Cumbria in 2016 and successfully led it out of special measures. He was then appointed chief executive of Cumbria Partnership in 2017, before the area was named in NHS England’s second wave of “integrated care systems” in 2018;
  • An OBE for the chief executive of North Middlesex University Hospital Trust Maria Kane, who joined North Middlesex in 2017. She previously led Barnet, Enfield and Haringey Mental Health Trust. North Middlesex had been slated to join the Royal Free London group but decided against this in October 2018;
  • Chief executive of Devon Partnership Trust Melanie Walker awarded an MBE for mental health and learning disabilities in the NHS. Ms Walker is a nurse by background;
  • Chief executive of Salisbury FT Cara Charles-Barks awarded an MBE. She is also a nurse by background and has held various management roles in both the NHS and in Australia;
  • Clinical accountable officer at Wolverhampton Clinical Commissioning Group Helen Hibbs awarded an MBE for services to NHS leadership;
  • Chief executive at Dorset County Hospital FT Patricia Miller awarded an OBE;
  • Chief nurse and executive director at Chelsea and Westminster Hospital FT Philippa Nighttingaleawarded an MBE for services to midwifery;
  • Chair of The Christie FT Christine Outram awarded an MBE;
  • Deputy national medical director for primary care at NHS England Rajesh Patel awarded an MBE;
  • Policy lead on workforce race equality standard at NHS England Syed Naqvi awarded an MBE for equality and diversity in the NHS;
  • Former chair of Western Sussex Hospitals FT and Brighton and Sussex University Hospitals Trust Michael Viggers awarded an MBE;
  • GP and former chair and current clinical director of the National Association of Primary Care, Nav Chana, awarded an MBE.
  • Former director of nursing, professional leadership at NHS Improvement Jacqueline McKennaawarded an OBE;
  • Former chief nurse at Sandwell and West Birmingham Hospitals Trust Elaine Newell awarded an OBE for services to midwifery; and
  • Former chief executive at Greater Manchester Mental Health FT Beverley Humphrey awarded an OBE.

No ifs, no buts, no public health cuts

NHS England has accepted the government’s announcement that public health should stay with local government, describing it as a “potentially workable solution”. But it added that “the quid pro quo will obviously need to be an end to cuts in local authority public health services and a guaranteed continuation of the ring-fence around the public health grant”.

These observations followed the health and social care secretary telling the Local Government Association that a review by his department had concluded local government should keep hold of its public health services.

Matt Hancock ended months of speculation when he said health visitors and school nursing services would still be commissioned by LAs, with sexual health services co-commissioned by NHSE and local government.

The long-term plan raised the possibility of the NHS taking over these services, much to the dissatisfaction of those in local government public health. The decision from DHSC was widely welcomed by that sector.