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.

History in the making?

Theresa May has said the government will reveal a new “sustainable long term plan” for the NHS over the next year, which will be backed by “a multiyear funding settlement”.

At the Commons liaison committee on Tuesday evening, she backed calls in recent months from Jeremy Hunt for a long term funding settlement and an “end to annual top ups of the NHS budget”.

The announcement received little coverage relative to its importance, but HSJ editor Alastair McLellan says the plan could be a historic moment for the NHS.

In his leader, he writes: “In January 1988 Margaret Thatcher appeared on Panorama to announce the review of the NHS that led to the internal market reforms. Almost exactly 12 years later Tony Blair chose Breakfast with Frost to declare NHS funding should be increased to match the EU healthcare spending average.

“Time will tell if Theresa May’s appearance in front of the Commons liaison committee… will take a similar place in the service’s history.

“What unites all three interventions without question is that they were all made with the aim of binding in wavering cabinet colleagues to the stated objective. Mr Hammond and the Treasury now have no choice but to back the idea.

“Quite how generous they will feel when it comes to providing the necessary funding is another matter – and an absolutely critical one.”

Magnificent seven

Health secretaries and national NHS leaders are only stewards of a very precious and decades old tradition – that of the service’s middle tier, and its many reorgansiations.

When opportunity opens up and their time comes to reshuffle the authorities, acronyms and offices before them, they are constrained not only by the weight of history on their shoulders, but also by Nigel Edwards’ Law. Named after the current Nuffield Trust chief executive and long time health policy hero, the rule dictates that no reorganisation of the NHS middle tier may settle on a number that has ever previously been used.

Simon Stevens, Ian Dalton, Matthew Swindells and colleagues were thankfully mindful of their responsibilities as they thrashed out the latest iteration, disclosed in new proposals for the two organisations to work more closely together including in regional offices, with single director teams. They came dangerously close to, but thankfully narrowly avoided, the eight regional offices of the 1990s and instead settled on seven regional teams.

“Seven?! WTF!?” you might ask. These patches apparently have their genesis in informal arrangements used to split performance management duties between the regional directors during the winter just gone. They include London, the South West, and the South East – which are already operating in this way (sort of, a bit). Then the North of England will be carved in two (North East and North West? Surely it can’t be that simple); and the Midlands and East region similarly (East Midlands and West Midlands? But what to do with the patch formerly known as East of England?).

Risk and reward

HSJ revealed a few important things on Monday:

  1. If clinical commissioning groups hit the mental health investment standard, funding for the sector will grow by 8 per cent by 2020-21; and

  2. 24 CCGs are forecasting reducing mental health spending for 2017-18 and 21 are predicting they will not hit the standard.

It is worth stressing that things are – on paper at least – moving in the right direction. CCG mental health spending has increased in both 2016-17 and 2017-18. Only 21 CCGs are predicting they will not meet the mental health investment standard this year.

The Five Year Forward View for Mental Health requires CCGs to invest an extra £1bn a year by 2020-21 from the 2015-16 baseline.

If they all hit the investment standard they will have increased mental health spending by £1.6bn in this period. This would be an 18 per cent increase, outstripping overall CCG allocation growth of 14 per cent over the same period.

Coupled with the forecast £744m of national savings the plans are meant to produce across improving access to psychological therapies, liaison psychiatry and crisis care, this creates a potential cushion of around £1.3bn.

But there are risks and HSJ’s forecasts only apply to a perfect world where everything goes to plan. With CCGs struggling to meet the standard and some even cutting spending, this is unlikely to be the case.

Midlands of opportunity

On Sunday, University Hospitals Birmingham Foundation Trust will take over its neighbour, Heart of England FT, to create one of the biggest trusts in the country.

The deal, signed by both boards this week, has been on the cards since UHB chief executive Dame Julie Moore took over leadership of HEFT in 2015.

Like other big mergers in recent years, UHB has been encouraged by regulators into the merger, which is seen as the solution to HEFT’s long running performance and financial difficulties.

However, unlike, say, Frimley Health, Dame Julie has said she’s not been able to extract any promises of financial support from the centre, despite trying.

In the short term, this will mean absorbing HEFT’s sizable deficit into the new organisation, which will keep UHB’s name.

The merger marks a remarkable period of consolidation in Birmingham and Solihull in recent years.

Birmingham Women’s and Children’s FT was formed in early 2017, and three of the area’s CCGs will also become one on Sunday (not to mention GP super-partnerships).

Further structural changes are unlikely in the foreseeable future, but mergers could be just the start of changes in how services are delivered in the region.