Your essential update on health for the week.

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories 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.

Sir Andrew Dillon will step down as the chief executive of the National Institute for Health and Care Excellence in March 2020 after more than 20 years in the role.

It takes a special kind of leader to oversee an organisation for more than two decades and the plaudits are well deserved.

NICE chair David Haslam said: “Sir Andrew has carried out this role for 20 enormously successful years, and everyone who knows him – whether in government, the life sciences industry, or in health and social care – is full of admiration for his calm and skilful leadership.”

NICE will advertise for a replacement in the autumn. He leaves some pretty big boots to fill.

On a few rare occasions, NHS trusts have been able to successfully challenge their draft inspection ratings from the Care Quality Commission.

The regulator has produced more than 600 overall ratings since it launched its inspection process in 2014. On four occasions, the provider has pointed out errors in the draft report which meant the overall rating was wrong.

Aligned views

With such high political stakes, it was always inevitable the NHS would be drawn into the increasingly tight control surrounding Brexit communications.

So it is really no surprise that diktats from the Department of Health and Social Care about Brexit-related messages are insisting arm’s-length bodies must toe the line coming out of Downing Street.

ALBs have been told to make sure such communications are “aligned” to the government’s latest core messages, which will be distributed each week, presumably to allow for subtle shifts.

Proposals to scrap restrictions on the number of patients who can sign up to Babylon GP at Hand’s new service in Birmingham were given the green light from the primary care commissioning committee of Hammersmith and Fulham Clinical Commissioning Group on Tuesday

The move is a key moment for the controversial digital practice’s expansion in Birmingham. It’s also an incredibly generous decision by the committee, given it is one which is likely to put more pressure on the CCG’s budget. 

Despite having patients registered from across London and Birmingham, Babylon GP at Hand operates out of a single practice in Fulham. This means Hammersmith and Fulham CCG is financially responsible for all of the patients the tech company signs up.

NHS England is consulting on plans which would require digital primary care services to establish new GP contracts and clinics in each area they wish to be a major provider. If the plans go ahead, this should offer some relief to Hammersmith and Fulham. 

Rocky relationship

Foundation trust boards have many key relationships, but one of the most important ones is likely to be with their governors.

In an ideal world, relations should be mutually supportive, giving both sides valuable insights and often a different perspective.

But not all trusts benefit from such perfectly harmonious relationships, with a review carried out for Surrey and Borders Partnership Foundation Trust laying out the problems which likely lurk in many trusts but are rarely voiced in public.

London calling

NHS trusts outside London must look on in envy at the income generated by private patients in the capital.

The Royal Marsden FT made £121m through its private patient units in 2018-19, representing more than a quarter of its total income.

The trust now accounts for 18 per cent of all private healthcare carried out by NHS organisations. Great Ormond Street Hospital for Children FT, Imperial College Healthcare Trust, Royal Brompton and Harefield FT, and Moorfield Eye Hospital FT are the next biggest beneficiaries.

Writing off a write-off

In his last months as NHS Improvement chief executive, Ian Dalton said government would “have to have a serious look” at writing off some of the debts incurred by providers, as it was “deeply unlikely” they could be repaid.

Trusts’ combined debts to the Department of Health and Social Care reached £14bn by the end of 2018-19, with more than half of that relating to around 30 providers.

The debt has risen steeply over the last three years, as dozens of trusts with budget deficits have become reliant on interest-bearing loans to maintain payments to staff and suppliers. The debts have now far surpassed trusts’ combined private finance initiative liabilities, which stand at £9bn.

The prospects of a write-off don’t sound all that favourable though, with the most indebted trusts telling HSJ this does not appear to be on the table.

NHS England’s Improving Access to Psychological Therapies scheme has opened access to counselling services for many people, with more than a million people referred each year.

Such demand for one-to-one interventions has meant IAPT has had to expand its workforce, with many areas turning to private providers to top up care from mental health trusts. 

In Kent, those private providers have been particularly prominent. But the decision by NHSE last year to require all practitioners to have completed an accredited course for the particular therapy they deliver has caused disruption.

A workforce review in Kent is believed to have shown many IAPT counsellors did not yet have the required qualifications. At one point, NHSE recommended restrictions on what work they should be allowed to carry out, which could have affected the ability of services to see those referred.

A compromise has since been reached, which allows providers extra time to make sure staff have the correct accreditation and should reduce the risk of patients not being able to see counsellors.