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.

Poor perceptions of exceptions

It has been two years since the implementation of the (controversial) 2016 junior doctors’ contract and so it’s high time to take stock of one of its key elements. 

If used properly, exception reporting should support safe staffing and protect junior doctors’ rights, but HSJ’s investigation has revealed discrepancies in the data reported by trusts and reports of bullying and intimidation from senior doctors not to report.

Even in the early stages of the investigation, it was clear there were huge differences in how trusts collect the data – and some of it didn’t make sense. How, for example, could any trust employing junior doctors have no exception reports, as four claimed to? 

Meanwhile, trusts employing a lot of junior doctors had fewer exception reports per doctor and, while it could be they are just unusually well-staffed, this seems too good to be true in the current NHS climate. The investigation also revealed that, in some cases, technology lets junior doctors down.

Current deficit

It’s not always easy to see what finances look like across a sustainability and transformation partnership area, so it’s great to see a clear explanation of what is going on in Kent and Medway appearing in local NHS organisations’ board papers.

However, what appears is not good news. 

The STP area is likely to end the year with a significantly larger deficit than it hoped at £113m against a plan of £77.3m, with limited scope to turn that around in the final months of the financial year.

The £180,000 question

Bonus payments in the NHS are always likely to be a hot potato, particularly given the financial pressures the health service finds itself under currently.

But the pressures on the NHS pound have not stopped some organisations from issuing bonuses of significant value, despite others ending the practice entirely.

In 2017-18, NHS Property Services paid £180,000 to four senior managers, with chief executive Elaine Hewitt alone pocketing £75,000. Unlike most of the other agencies it is established as a private firm, albeit one wholly owned by the secretary of state for health and social care.

The company topped the ranking for bonuses paid to senior staff by national health agencies, with an amount more than six times the average for the year (£27,400).

Long road ahead

The road to integrated care has so far been anything but a smooth one for the NHS, especially when it comes to creating brand new walking, talking integrated care providers. 

Dudley, the area which is closest to achieving the model, has recently suffered its third timeframe setback. Last year, commissioners in the area launched a procurement process to award a multibillion pound integrated care contract.

But, while the clinical commissioning group has largely finished its due diligence in relation to the procurement on a local level, it appears the vehicle it wants to use to hold the contract is not ready at a national level.

The chosen vehicle would be an NHS first, which somewhat complicates the matter. Aside from figuring out how to legally create the new trust, regulators also have to create new assurances and regulatory approaches.

All of this, it seems, has pushed back the CCG’s ambitions to 2020.

NHS no-deal dream team

Brexit continues to suck the life out of everything in its wake like a supersized Death Star.

The latest casualties are roughly 200 NHS England and Improvement staff, including NHS England director of acute care Keith Willett, who have been recruited to a team preparing the NHS for a no-deal Brexit.

Professor Willett will head the team from across NHSE and NHS Improvement’s national and regional staff, alongside NHSE’s national operations director Matthew Swindells.

The move comes at a critical time for Professor Willett’s core policy area. The NHS clinical review of standards, which is due to publish recommendations in the spring, is considering changing the four hour target.

During peace time, such a review would be occupying a considerably higher profile.

Professor Willett being seconded at such a time is yet another example of the staggering resource burden Brexit is placing on the NHS. 

Show me the method

The government’s new funding settlement has offered a welcome shift away from short term gains and unrealistic expectations when it comes to NHS finances.

It was encouraging, for example, to hear national leaders issue warnings about backloaded savings plans, and confirming that control total targets would be rebased to 2017-18 outturns.

The trust specific control totals have now been issued to trust leaders, who have been working through the detailed assumptions. Several finance directors told HSJ they are cautiously encouraged by the numbers, as well as the new measures that come with them.

For example, trusts will no longer be able to use land sales to meet their control totals, which had a disturbingly distortive effect on the sector.