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.

Outside help

Procurement teams across NHS trusts are bracing themselves for more change.

HSJ revealed NHS Improvement is bringing in management consultants to help design a new procurement operating “model” for trusts in a fresh bid to deliver on Lord Carter’s £5bn efficiency challenge.

The news that consultants are being drafted in was met with scepticism by the Health Care Supply Association, which pondered why NHSI couldn’t use the health service’s existing procurement expertise.

However, NHSI said the consultants, in addition to drawing up at least three options for the new model, will advise on “private sector expertise and best practice”.

Under pressure

In the early years of austerity, there was lots of scope for NHS accountants to shake the magic money tree and deliver helpful one off adjustments to boost their organisation’s reported financial position.

But, the opportunities have started to run thinner, leading to greater temptation and pressure to make adjustments where the case is not so clear.

Survey responses collected by the Chartered Institute of Public Finance and Accountancy suggest a significant number of NHS staff have carried out “professionally unethical” tasks after feeling pressured to do so.

Although the sample size was small, Margaret Pratt, chair of CIPFA’s ethics working group and former interim chief finance officer at St George’s University Hospitals Foundation Trust, told HSJ: “The main thrust of the survey results is very clear. People feel under pressure to act unethically, and more worryingly, people know what they’re being asked to do is wrong and yet they are still doing it.

Too great expectations

A trust chief executive has panned regulators over the decision to withhold winter capital funding, warning it was the patients who would ultimately suffer.

Chief executive for Mid Cheshire Hospitals FT, Tracy Bullock, said the funding, which the trust had initially successfully bid for, had been earmarked for a portable ward to expand its accident and emergency department capacity during the frostier months of the year. 

Why was the funding denied, you ask? Ms Bullock told HSJ the trust would not meet three conditions prescribed by the regulators. According to the trust, these were:

  • Reduce A&E four hour breaches by 50 per cent over winter
  • 2018-19 financial plans must not be impacted by any work related to the funding
  • Funding must be spent by 24 December 2018

NHS England said the trust application was not approved because it did not meet criteria.

HEE gets its share of the fudge

Among local NHS leaders, Health Education England has in recent years become the least popular NHS quango in a supremely competitive field.

That is a situation not all of its own making: Many would name staffing as their biggest problem, and HEE has become the target of much anger because it often can’t help.

Yet the level of irritation also suggests HEE’s leadership hasn’t done everything right. It also means the news the organisation is having its wings clipped, got a pretty warm welcome in the sector.

Both the circumstances of the announcement, and the detail of it, give rise to a little bafflement.

Procedures of low financial value

While it’s eye catching that a hospital trust is considering approaching its local Premiership team for funding (via a surcharge on food and drink), arguably more significant is the proposal to start offering procedures of low clinical value privately.

North Middlesex University Hospital Trust admits this idea would only raise a small amount of money, but it has a policy implication that is far larger.

Procedures of low clinical value were something the NHS was supposed to stop doing because they were largely ineffective. It was sold that way, with the lowered cost of not providing them on the NHS being a happy side effect.

Offering them privately at the same facilities where they were once part of the NHS offer will be more disturbing to the public than a link up with the football club.

Who pays for what is a fundamentally political decision.

Battle to reduce A&E cancer diagnosis goes on

Being diagnosed with cancer in an emergency department is not a good sign. It is used as a proxy indicator for late stage cancer and, therefore, poor rates of survival.

It is good news, therefore, that the variation between the best and worst performing clinical commissioning groups seems to be shrinking. Public Health England this month released the final tranche of data from 2017, giving us six complete years of data on the proportion of malignant, invasive tumours diagnosed in A&E.

The data shows the range between the CCG with the highest proportion and the lowest in 2012 was 15 per cent. Last year it was 12 per cent.

There are still plenty of CCGs reporting A&E diagnoses rates over 25 per cent and a small group of urban areas with high levels of diversity and deprivation keep popping up in the top 10 worst performers.