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.

Bid for your buildings

Perhaps given the lack of capital available for the NHS to spend on its estate, Department of Health and Social Care officials have turned their attention to making the best of what the service already has.

One example of this thrifty thinking is a recently revealed policy that allows trusts to apply for ownership of buildings which are on their estate but currently belong to NHS Property Services and Community Health Partnerships.

The scheme has potential – the combined portfolio of the two organisations accounts for over 10 per cent of the overall NHS estate.

Injustice for the vulnerable

The national learning disabilities mortality review programme, or LeDeR, was designed to offer a system for local areas to review cases, learn from mistakes and implement changes. 

But, for this system to work, families must have confidence in it.

So HSJ’s revelation of how one CCG tampered with a high-profile report into the death of 18-year-old Oliver McGowan paints a bleak picture of a process susceptible to watering down and altering by local commissioners and decision-makers who were not involved in the original reviews. 

MAC-ing a list

In the first full review of the shortage occupation list since 2013, the Migration Advisory Committee has recommended all doctors should be added because of “high vacancy numbers, poor workforce planning and a high leaving rate”.

However, MAC chair Alan Manning told HSJ  the difference this would make for trusts would be “not much in practice”, as problems recruiting doctors from overseas were eased after they were removed from the tier 2 visa cap last year. He added this was more about sending a message than a drastic change, although doctors would see “slightly lower visa fees”.

The suggestion represents a broadening of policy. Previously only consultants in clinical radiology, emergency medicine and old age psychiatry, certain emergency medicine trainees and core trainees in psychiatry were on the list.

Accounting speak

A lack of clarity over funding and all-round financial pressures have increasingly prompted auditors to raise concerns over the viability of NHS trusts.

In accounting speak, this means there are lots of “material uncertainties” being raised around the “going concern” basis of many providers.

In normal speak, this means many trusts have become heavily indebted to the Department of Health and Social Care, and continue to spend far more money than they receive.

In a letter seen by HSJ, the DHSC essentially tells trusts not to worry, as they will continue to provide bailout cash so staff and suppliers can be paid.

Slipping through the net

Public sector pay-offs have provided many headlines for the tabloids over the last few years. Senior executives leaving with hundreds of thousands of pounds were an easy target for both the media and for politicians who wanted to show how tough they could be when taxpayers’ money was involved.

The £160,000 cap on public sector redundancy payments, introduced in 2015, should have put a stop to this.

It now looks like these changes were not incorporated into every NHS’ worker’s terms and conditions. While they were automatic for those on Agenda for Change, they had to be incorporated into very senior managers’ contracts.

But a few contracts seem to have slipped through the net. While no one is willing to say specifically what happened in the cases of Tony Bruce and Wendy Kerr, who left East Staffordshire Clinical Commissioning Group with payments above this, the references in an independent investigation ordered by NHS England to “prior contractual requirements” suggest that their contracts were left unchanged.

The probe into their pay-offs has left them both with amounts well above the £160,000 maximum: £259,689 for Mr Bruce, who was the accountable officer, and £202,183 for Ms Kerr, who was the chief financial officer. The pair were made redundant in 2018 when a combined management team was set up for Staffordshire’s CCGs.

Following suit

The long-standing separation of primary and secondary care is coming to an end in a handful of areas, as more GPs begin to see the drawbacks of running their own practice.

Under a model which was expected to spread to other areas, multiple practices in Wolverhampton are now run by the acute trust, with GPs voluntarily giving up their NHS England contracts to become salaried employees.

The high-flying St Helens and Knowsley Teaching Hospitals Trust is now following suit and hopes to be running six practices within two years.

It already runs one practice, which it took over when the partners pulled out in 2017, and is currently in talks to run five more.