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.

Winners and losers on finance

At 00.01 Thursday NHS Improvement released the financial and performance results for the trust sector for 2017-18.

They were not pretty reading, with a significant overspend on staffsliding access performance and some eye-popping deficits at individual trusts.

The Nuffield Trust’s Sally Gainsbury warned that the true deficit figure across the sector was closer to £4bn. Other commentators said the mismatch between what the NHS was being asked to do and what it was being funded to do was becoming clearer and clearer.

At a micro-level, individual trust performance on finance showed how difficult planning can be, with one trust’s position slipping by £90m compared to what was predicted at the start of 2017-18.

King’s College Hospital Foundation Trust’s slide was dramatic but it was not the biggest single deficit, with Barts Health Trust ending £130m in the red (although Barts were allowed to access its sustainability and transformation funding anyway).

Elsewhere, trusts ended up with large surpluses after land sales meant they hit their STF targets and dragged more STF out of the centre.

Whatever its earlier success in helping distressed providers, the extremes of surplus and deficit the STF double-jeopardy produces make NHS finance ever more bizarre.

Jeremy Hunt: a ‘good’ health secretary?

HSJ editor Alastair McLellan writes about health and social care secretary Jeremy Hunt’s contributions to the health service as well as his mistakes. 

He says Mr Hunt’s most significant contribution to the sector is the Care Quality Commission. Very few in the NHS are going to love an inspectorate (nor indeed, any Conservative health secretary), but quality and especially patient safety are now higher on the agenda than they have ever been.

At first, Mr Hunt opted for the usual levers of regulation, criminalisation and command. But unlike most previous health secretaries, he also opened his department to harmed families. Post Mid Staffs he has met many of them, often against civil service advice, and never sought publicity for it. It may have started as a ploy, but the experience clearly influenced him.

He has been captured by his brief and even many cynical NHS leaders accept his genuine commitment to improving safety, and that his years in the job have brought him useful perspective.

Read the full article here

Happy birthday

When the Care Quality Commission announced that Ian Trenholm would be its next chief executive, the regulator cited his “track record of delivering technological innovation at scale” as one of the deciding factors.

But documents seen by HSJ raise doubts over Mr Trenholm’s record at NHS Blood and Transplant, where he leaves a multimillion IT project which has been plagued by delays, rising costs, senior management disagreement and resignations.

Despite £23m being spent on the programme, none of the electronic clinical services originally planned are up and running, according to the report. It says the only parts of the project to have gone live are a system for sending donors a “happy birthday” message and a venue and appointment booking service.

NHS BT said responsibility for the project had recently shifted to another senior manager as part of a “long planned move”; while a CQC spokeswoman said “all appropriate due diligence processes were followed” including “receipt of detailed references and conversations conducted with senior leaders in the health system”.

Trusts facing the costs of fire safety warnings

Almost a year since the Grenfell Tower disaster, HSJ has revealed that several trusts are still yet to deal with fire safety risks raised by cladding on their buildings which were inspected after the tragedy last year.

HSJ has also reported that at least seven trusts served with fire enforcement notices with some saying the work is not expected to be completed for another year.

In a number of cases the costs of upgrading the buildings, which at the Mid Cheshire Hospital Trust date back to the 1970s, could run into millions.

Mind the gap

A new analysis from the Nuffield Trust has delved deeper into the gender pay gap in the NHS and revealed that even for a staff group that is 81 per cent female, men still come out on top.

At first glance the 3.9 per cent Agenda for Change pay gap favourable to women looks like good news, but in reality, men are “disproportionately” represented in the higher pay bands, according to the think tank – the overwhelming female majority is what accounts for the 3.9 per cent figure.

For staff not on the AfC contract, such as doctors and managers, the situation is even more challenging as there is a 47 per cent pay gap in favour of men. The Nuffield Trust explained this is down to significant imbalances between the numbers of male and female highly paid medical consultants.

Safety in the independent sector

The Ian Paterson case, which saw a disgraced surgeon jailed for 20 years last August, brought unprecedented scrutiny onto the private healthcare market – a market that isn’t hugely private, considering the NHS makes up roughly 40 per cent of its revenue.

In an interview with HSJ this week, the medical director of the NHS Partners network (the part of the NHS Confederation representing independent providers) said not only that private hospitals were “willing to learn and improve”, but also that they would do so quicker than their NHS counterparts.

Howard Freeman also rejected any suggestion the sector took the easier, more profitable cases and said in some cases the NHS was to blame for a lack of transfer arrangements if something went wrong in a private hospital.

The interview comes after warnings on patient safety in independent hospitals from the Care Quality Commission and Jeremy Hunt.

Another merger?

NHS mergers are back in fashion, and two organisations in the South West could be next in line.

Royal Devon and Exeter Foundation Trust will share its chief executive and chair with Northern Devon Healthcare Trust from 18 June, if both boards approve proposals for a new collaboration agreement.

A number of neighbouring trusts in England have moved to share chairs and chief executives, and in several cases this has been a precursor to a merger or acquisition.

The Devon deal stems from long-standing problems at Northern Devon Healthcare Trust around recruitment and financial sustainability, and more recently, instability of its senior leadership.

NDHT is an isolated provider and locals have campaigned hard to keep emergency services at the trust.

Backtracking on rationing

The Equality and Human Rights Council rarely features in HSJ but Sharon Brennan reported on 13 clinical commissioning groups U-turning on a funding decision after the threat of legal action from the EHRC.

The council had written to the CCGs in March warning them their proposed policies on the care of people with some serious long term health conditions might be unlawful and “dehumanising”.

NHS continuing healthcare budgets pay for community care for people with conditions or disabilities with a primary medical care need.