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.

Doomed to repeat?

Well, here we go again. Local health systems will be told to draw up new five year plans, once their beefed up funding allocations have been confirmed.

These will replace the previous five year plans that were drawn up by Sustainability and Transformation Partnerships in 2016, which quickly unravelled once everyone (including the government, eventually) realised there simply wasn’t enough money to deliver them.

There is more money this time, which means the efficiency challenge is broadly half that of the previous plans. But the extra investment will need to be spent extremely wisely.

Inflation theory

The steep interest charges that come with private finance initiative deals have long raised concerns in the NHS, but less is known about the inflation charges that many providers have to fork out.

For the first time, the RPI linked charges have been set out in detail by the Centre for Health and the Public Interest think tank, which has highlighted the “crippling” costs facing many trusts over the next decade.

For some providers, including Norfolk and Norwich University Hospitals Foundation Trust and Barts Health Trust, the inflation charges are actually larger than the interest element of their unitary payment.

Filling the gaps

The global nursing shortage is one of the biggest concerns for NHS leaders, with frequent rota gaps presenting real challenges for patient care. It was perhaps then inevitable that trusts would start stuffing the gaps with healthcare assistants instead.

New research from BPP University School of Nursing collected data from 195 trusts showing HCAs now account for three in 10 care roles in the NHS.

The East of England was found to have the highest proportion of HCA staff in the country, with almost one in three staff in the region working as an assistant. It was found that the number of nursing vacancies rose by 46 per cent – which represented the biggest rise in any region.

The danger here is that there is widespread evidence that substitution of registered degree nurses with less well educated or trained care staff does lead to increases in patient harm and mortality. This has been known for some time.

Wolves at the door

The chief executive of a relatively high performing trust has let rip on his struggling neighbour.

David Loughton, of Royal Wolverhampton Trust, accused Shrewsbury and Telford Hospital Trust of “poor planning” in relation to its proposed closure of Telford’s emergency department overnight.

Mr Loughton, who described himself as “pretty angry”, claimed Shrewsbury missed opportunities to address the workforce issues in its accident and emergency two years ago, and is worried about the impact it will now have on his own organisation.

Head in the cloud

Health and social care secretary Matt Hancock elaborated further on his enthusiasm for all things digital, by publishing a “tech vision” for the NHS.

The document included a few details that fleshed out an emerging NHS IT strategy based around strictly enforced national standards and (relative) local flexibility.

For the first time, Mr Hancock said NHS digital services and data should shift from servers within trusts to “the cloud” (ie online).

If implemented universally, this would be a big (and costly) shift of NHS IT from locally owned hardware to massive data centres owned by the likes of Amazon, Microsoft or IBM.

Moral compass

It’s goodbye to another long serving NHS chief executive, with Ron Shields announcing his retirement from Dorset Healthcare University FT.

He has been an NHS chief executive for 21 years, the last five of which were spent in Dorset. Mr Shields was previously at Haringey Community Healthcare Trust and Northamptonshire Healthcare FT.

When he joined DHUFT on an interim basis in 2013, the community and mental health trust was subject to formal regulatory action. But this concluded in 2014 and earlier this year the trust was rated “good” by the Care Quality Commission.

Trust chair Andy Willis said Mr Shields had shown “passion” in the job and had a “clear moral compass”.

Tech up

The NHS will need an investment of up to £13bn to support its technology ambitions over the next five years, HSJ has been told.

The estimate, which equates to between £2.1bn and £2.8bn per year, forms part of technology and digital workstream being developed for the plan.

There are caveats around these figures but, if accepted, it would be an even bigger investment in technology than the much maligned National Programme for IT.

NHS England’s response when approached about the figure was acerbic, suggesting it may be a little premature to declare NPfIT 2.0 quite yet.