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.

Third quarter update

Another year, another big provider deficit.

NHS Improvement’s latest forecast for 2018-19 suggests a year-end deficit of £661m, against the planned £394m.

And the forecast would have been worse, at £917m, were it not for a fortunate accounting adjustment relating to two Carillion hospitals which have been brought on to the government’s books as “part-donated assets”.

The actual year-to-date position after the third quarter suggests a slight improvement on 2017-18, but significant deterioration on 2016-17.

While the drive for integration is clearly a major factor in Simon Stevens’ looming takeover of NHSI, the failure to make better progress in clearing the deficit was surely also a factor in Ian Dalton’s imminent exit.

New chief in town

The Nursing and Midwifery Council’s new chief executive Andrea Sutcliffe has set out her vision for the regulator and is determined to ensure the NMC takes a more nuanced view of care failures involving nurses.

In particular, her comments around highlighting wider issues is a welcome step given the repeated failures of all regulators to spot and take action on systemic issues.

Saving for retirement

The proportion employers are expected to contribute to the NHS Pension scheme will rise to 20.7 per cent next month, up 6.3 percentage points from the current 14.4 per cent. 

The rise is going ahead despite respondents to a recent consultation on the topic raising concerns about the potential havoc the financial burden would cause, with some noting such an increase would force them to review their workforce.

The Treasury, importantly, has confirmed that its agreement with the Department of Health and Social Care last year over NHS funding will be honoured, meaning the additional cost for employers will be covered until 2023-24.

Some back of the envelope mathematics suggests the rise will equate to several billion pounds extra each year, so it is perhaps worth keeping an eye out for any creative accounting from government.

What the watchdog did next

Although it acquired new powers to prosecute for failing to provide safe care in 2015, the Care Quality Commission has only so far used them against one trust – Southern Health Foundation Trust – which was prosecuted after a patient fell from a roof.

That was until this Tuesday, when it emerged the CQC would be charging Sussex Partnership Foundation Trust over accusations it failed to provide safe care and treatment of a prisoner in the healthcare section of HMP Lewes who hanged himself. As in the Southern Health case, the trust was accused of breaching a “fundamental standard”. 

Running out of road

The various window dressings that have been applied to the NHS’ revenue position since 2014 have now largely run out of road, meaning providers will be embarking on the long-term plan from a worse position than the government may have realised.

Not only are these accountancy measures now unavailable to offset unplanned overspending, some of them will actually have to be reversed, placing an additional cost pressure on the revenue budget.

One early example is an update from the Royal Institute of Chartered Surveyors around accounting for asset lives, which is affecting dozens of providers. The update clarifies that a practice of extending the expected life of building assets, to enable less money to be left aside for repairs and replacements, does not comply with the official guidance.

Essentially, these trusts will now have to revisit their asset lives and face higher depreciation charges. The overall impact on the sector could be more than £100m.

More questions

The latest revelations on the “toxic” culture in Sheffield Clinical Commissioning Group raise yet more questions about what’s going on there, and little by way of complete answers are being provided.

HSJ has recently learned NHS England was warned about “unrelenting bullying” by senior managers at the CCG more than a year ago, when a letter was written by an employee and sent to then chief nurse Jane Cummings in 2017.

This letter does not appear to have been taken into account when the national commissioner completed its recent independent investigation into the CCG. Why so?

The CCG has said the letter was thoroughly investigated and that it took action.

Looking from the outside in

NHS Improvement has announced it will immediately disband a panel it had created to review the findings of the independent investigation into Shrewsbury and Telford Hospitals Trust’s alleged maternity failings.

This announcement followed HSJ approaching the regulator last Friday with further evidence of possible conflicts of interest. This was after HSJ learned the Care Quality Commission’s representative, Nigel Acheson, had led a CQC inspection of the trust in December 2016 which may come under scrutiny for being too uncritical.

A problem shared

In Kent and Medway, the aim is to create a “single service” for pathology across the area’s four acute trusts. Debate continues on how that will play out in practice.

But there’s a salutary lesson in a much smaller merger in one part of the county. Since last June, a single lab in Dartford has handled non-urgent blood specimens for both Dartford and Gravesham Trust and Medway Foundation Trust. In that time, nearly 3,300 patients have had to be recalled for repeat testing, with samples going missing, being left too late to be tested, and reporting systems failing.

A harm review is now taking place with an independent review by the Royal College of Pathologists to follow. That should provide some pointers of what to avoid for any future Kent and Medway-wide reconfiguration of services.