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.
A plan for the plan
The scope of the long term NHS plan promised by the prime minister during the spring finally began to fully reveal itself.
Former health and social care secretary Jeremy Hunt, his successor Matt Hancock and NHS England chief executive Simon Stevens had already dropped heavy hints about what the plan might contain and the announcement of 14 “workstreams” to develop ideas for the plan therefore contained few surprises.
As expected, cancer, mental health and cardiovascular will be among the plan’s “clinical priorities”, but these were fleshed out with the addition of respiratory to the latter’s workstream and a standalone group on learning difficulties and autism.
NHS England and Improvement told HSJ there may be “up to” 20 workstreams when the plan’s scope is complete.
£600m worth of savings at risk
Procurement challenges often result in dreary court cases where minor points are endlessly quibbled, but the battle between the Department of Health and Social Care and DHL Supply Chain is anything but boring.
DHL Supply Chain, the incumbent provider of the expiring NHS Supply Chain service, has taken the DHSC to court after missing out on a £730m logistics contract tendered as part of a new procurement model for the NHS.
The company, which hit the news in spring for its failure to deliver enough chicken meat to KFC, accused the department of “misdirection” and making “manifest errors” during the procurement.
If the issue is not resolved by September, then the model’s implementation will go beyond the already extended deadline of April 2019, coinciding with potential uncertainties arising from the UK’s scheduled exit from the European Union.
Ask the cancer patient
NHS England has been urged to stop a “perverse” policy of withholding transformation money from areas breaching the 62 day cancer target.
John Baron, who stood down as chair of the all party parliamentary group on cancer last month after nine years, told HSJ it was “perverse in the extreme” to withhold funding from areas, which seemingly need the money most.
The £1.8bn “sustainability and transformation fund” has been issued on a similar basis, with those holding the purse strings reluctant to hand out money for nothing, or to reward failure.
But is this really the fairest way to allocate funding and drive improvement? A cancer patient finding themselves in a poorly performing area by no fault of their own would likely argue that it isn’t.
The fallout from last year’s highest profile NHS financial collapse continued with the publication of a second review into the organisation’s governance failures.
A review by Deloitte, which was commissioned by NHS Improvement, was heavily critical of the abilities of chief executive Matthew Hopkins to lead a financial turnaround at Barking, Havering and Redbridge University Hospitals Trust, and gave further context to his departure at the end of last month.
There was also some difficult reading for the trust’s former interim finance director Steve Collins, non-executives, and even the trust’s medical director.
Taking on the consultants
There are clearly significant issues to deal with among the trust’s clinical workforce as well, with Deloitte highlighting tensions between the medical director and consultant workforce.
The experience of Nadeem Moghal, the trust’s medical director, illustrates the difficulty of taking on difficult consultants within the NHS.
Deloitte said Dr Moghal had sought to tackle “inappropriate behaviours” among the trust’s medical consultants, including around their private patient activities, but that this had created tensions, which may now mean it is difficult for him to stay in his post.
Clinical commissioning groups and NHS trusts have been given yet another performance target to focus on.
In a bid to cut waiting times, increase capacity ahead of winter, while also saving some pennies, NHS England and NHS Improvement have asked local areas to adopt funding schemes to reduce “excess bed days” within acute trusts.
An excess bed day is effectively a fee that a CCG must pay when a patient stays in hospital for longer than a pre-determined time.
In a letter, the two national bodies told local leaders they should agree a baseline level of excess bed days, which CCGs would have to fund, and with this a target to reduce bed days below the baseline.
Dalton reveals vision for NHS Improvement
NHS Improvement is to scrap its regulation department, with its responsibilities largely devolved to seven new regional directors.
In his first major interview since taking over at NHSI, Ian Dalton said new regional directorates, which will be jointly operated by NHSI and NHS England, will become the “most significant regional entities we’ve had for a number of years”.
He said the changes are being made as part of a radical rebuilding of his organisation, which will be more focussed on supporting and improving trusts, alongside its formal regulatory functions.
He also warned trusts they would need to make significant savings again in 2018-19, above the 4.3 per cent many providers missed in 2017-18.
Mr Dalton also recognised a crisis of leadership at senior board levels and said the NHS had to stop treating senior directors like football managers, who are famously given very little time to turnaround poor performance.