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.
The move of NHS England’s chief digital officer Juliet Bauer to digital GP company Livi, and her subsequent ill-advised column, prompted a flurry of discussion about the so-called revolving door between tech companies and the NHS.
NHS England has now provided some more clarity in response to the concerns raised by the Commons health and social care committee.
When Ms Bauer moves to Livi in April, NHS England has said she will not be able to “lobby” government, including central bodies like NHS England, for six months.
But the letter is silent on whether Ms Bauer, or anyone else off to work for a supplier keen to expand its NHS business, can lobby local NHS organisations. After all, it will be clinical commissioning groups and GP groups, rather than NHS England, signing contracts with digital GP companies, and Livi’s NHS contracts to date have been with GP federations.
Gone cap in hand
With no commissioning “risk reserve” in place for 2018-19 – as in the previous two years – a significant deficit in the provider sector was always likely to cause a major headache for the Department of Health and Social Care.
Predictably, providers look set to report a deficit approaching £1bn, and with the department and NHS England seemingly unable to cover this off by holding back spending in other areas, they’ve had to go cap in hand to the Treasury.
Liz Truss, chief secretary to HMT, has approved a £600m transfer of reserve funding to the DHSC to help avoid an embarrassing budget breach, which is described as covering “unforeseen” cost pressures.
GP out of hand
As the local commissioning chief executive put it, approval for GP at Hand’s expansion into Birmingham had an air of inevitability about it. But that does not make it less momentous.
What GP at Hand proposes in Birmingham is unprecedented. Patients in the city would be able to register with GP at Hand’s physical practice, based 130 miles away in Fulham. There would be a physical satellite clinic in Birmingham but most of the care would be delivered digitally, through video consultations, on a patient’s smartphone.
GP at Hand is planning to roll this model out nationally and has already approached people in Southampton and Leeds.
But GP at Hand will face increasingly stiff competition both from GPs upping their digital game and other digital health companies. The service may not prove as popular elsewhere, or GP at Hand itself may face fresh regulatory difficulties.
HSJ pointed out in January that several chief executives in the north east were paid considerably more than their counterparts in similar trusts elsewhere. There’s now the first sign that salaries in the region are falling back into line with elsewhere.
Ian Renwick’s replacement at the helm of Gateshead Health Foundation Trust is expected to be paid at least £62,500 less than he was. The proposed salary for the £264m turnover trust’s incoming chief executive is advertised at between £182,500 and £202,500. That’s in the upper half of the rate NHS Improvement has indicated would be appropriate for a trust of that size but it is notable that the trust had spoken to NHSI before setting this range.
Mr Renwick – who was dismissed last year for reasons not made public – was paid salary and fees of between £265,000 and £270,000 in 2017-18.
Trouble in Luton
One of the original eight integrated care systems is now preceding without the involvement of one of its four local councils.
Bedfordshire, Luton and Milton Keynes ICS has had to agree new governance rules with Luton Council after the latter said it no longer wished to be a signatory to the ICS process.
The council pulled out of involvement over concerns that the process was “pre-determined” and “disempowered” local decisions. The Labour council also said it was “politically opposed” to the ICS.
Expect more of these type of issues to emerge as systems try to solve these competing and sometimes contradictory interests.
Barts Health Trust can claim to be the largest in London and its heritage includes being the inheritor of the oldest hospital in Britain. NHS Improvement has accepted the recommendation from its fellow overseer, the Care Quality Commission, to take Barts out of quality special measures after four years under the regime.
However, its troubled Newham site has drawn fire for its “inadequate” maternity services.
Staff from the emergency department in Whipps Cross hospital sought out inspectors to complain of “cliques, favouritism and passive bullying”.
Twisting your ALBs
How long is an arm? If you are an arm’s length body in the NHS, you might be forgiven for feeling the answer is “not long enough”.
The Department of Health and Social Care’s communications director has “reminded” ALBs that pretty much anything said to the outside world which touches on Brexit needs to go through an approval process. That’s not only press releases but also tweets, emails to suppliers and even phone calls with the public.
It’s not just DHSC officials overseeing these communications either – in some cases, ministers and the Department for Exiting the EU are involved as well.
This grand scale micromanagement points towards an intense nervousness in Whitehall and among ministers about how the risks of Brexit are conveyed to the public.
Hancock intervenes, CQC retreats
The Department of Health and Social Care had been rumbling along on developing a replacement for the central IT contract for more than a year before Matt Hancock’s arrival.
Atos had been providing desktop IT to DHSC, NHS England/Improvement, the Care Quality Commission and the Health Research Authority for years and discussions for a replacement were all at an advanced stage.
However, the health and social care secretary, in August, ordered a halt to work on a replacement contract and a review that would explicitly consider switching to Google, as opposed to Microsoft, software.
As recently revealed by HSJ, in November, the CQC decided to opt out of whatever resulted from Mr Hancock’s review, saying what was proposed no longer met the organisation’s needs and it would be doing its own thing.