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.

Two to tango

NHS Improvement chair Dido Harding told private providers the seven new regional directorates would become “fiefdoms… over my dead body”, as she sought to reassure them the NHS would become more open to using their services.

She pledged a more collaborative culture would be fostered and said she accepted criticism from independent sector providers that the NHS was “shutting them out” of discussions and service provision.

The argument that the NHS must change its culture and approach to the private sector is a valid one. But private sector providers must also consider their approach to the NHS and why they are often greeted with such scepticism.

It takes two (or more) to tango and cultural change will be required on all sides.

King’s of the deficit

It will likely be a while before King’s College Hospital Foundation Trust comes out of financial special measures.

The trust’s finances have imploded pretty spectacularly over the past 18 months and the report commissioned from PwC does not give a lot of detail on just how NHS Improvement came to be quite so surprised by its repeated reforecasts.

One cause of the deficit? They hired a load of doctors and nurses.

What the public would hope a hospital would do, but again a problem for central NHS bodies who appear not to have known the trust was going big on recruitment (to hit waiting time targets and provide safe care) until the finances had comprehensively tanked.

Who, what, where, when and why

The level of transparency around governance when it comes to NHS Improvement and trusts whose finances have exploded is poor.

Gloucestershire Hospitals FT had one of these incidents in 2016. Nearly the whole board was replaced when it was revealed three years of surpluses had in fact been underlying deficits.

The trust moved out of financial special measures last week but there is still a lack of clarity over what actually happened there.

Of the 30 page abridged version of the report commissioned from Deloitte, just two focus on what went wrong. The report essentially blamed the chief executive and finance director for deceiving the rest of the board, who did not know or did not ask enough about why suppliers were being paid late, low levels of cash and “significant swings in financial performance”.

What reports such as these either don’t ask or don’t disclose is how the regulator Monitor (now rebranded as NHS Improvement) came to be so deceived. You’d think the people from Deloitte would look at what the trust was communicating to its relationship manager at the regulator – but not a word.

Open all hours

There is plenty of competition to be the canary in the NHS coalmine, but GP out of hours services probably have a strong claim.

As working as a GP has got tougher – with practices often functioning one GP down – and indemnity insurance has rocketed, out of hours services are finding it harder to fill their rotas.

As HSJ reports, this means out of hours services sometimes end up with fewer GPs on duty than planned.

The Care Quality Commission reported in June that the urgent care sector faced many challenges, including workforce. With contracts for out of hours priced at about £8 per patient per year, there is not much money to play with.

The Weston question

The fate of one of the NHS’ smallest emergency departments will be decided “later next year”, commissioners have announced – a decision which will be closely watched by other health economies with similar headaches.

Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group said the future options for Weston Hospital’s emergency department would be discussed as part of a wider public consultation scheduled to be launched in early 2019.

The unit has been closed overnight since June 2017 after the CQC rated the A&E department “inadequate”. 

Money talks

The government has committed £20.5bn real growth to the NHS and, as many have noted, will want its pound of flesh. Thus far, that price appears to be a few sketchy press releases.

Theresa May previewed cancer commitments from the NHS long-term plan at the Conservative party conference, Philip Hammond brandished an “at least £2bn” for mental health ahead of his Budget last month; and this week it was decided that £3.5bn was an appropriately big number for the prime minister to commit to primary medical and community health services.

These announcements can do little in material terms, and the big numbers don’t mean a lot, but they can send the signal of what government wants – for whatever that is worth these days.

Speaking of money

Commissioners in Staffordshire have revealed their bottom lines will sink £27m into the red – despite agreeing to a surplus control total at the beginning of the year.

In recent board papers, North Staffordshire and Stoke on Trent CCGs said they are set to miss their £6.6m control total by just shy of £35m.

What has happened to the CCGs’ finances between agreeing their control total at the beginning of the financial year and now? Both commissioners ended 2017-18 in the black, albeit not by a substantial sum, so it seems surprising they have shifted so much in the other direction in just six months.