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.

VAT’s not allowed

The establishment of wholly owned subsidiary companies by NHS trusts has become a hot topic.

Unions and left leaning politicians have criticised the moving of non-clinical staff into such companies, while others argue it enables cash strapped trusts to deliver VAT efficiencies and explore commercially beneficial solutions.

The Department of Health and Social Care is working with NHS Improvement to increase their oversight of trusts’ use of wholly owned subsidiaries, which will allow for “timely intervention” if necessary.

Third private hospital in special measures

The Care Quality Commission rated the Huntercombe Hospital Roehampton as “inadequate” overall following an unannounced inspection in May.

It is the third mental health unit run by Huntercombe Group to be given the worst overall rating and placed into the special measures regime since mid 2016.

Huntercombe Hospital Stafford was rated “inadequate” and placed in special measures by the CQC in August 2016, but has since been upgraded to “requires improvement” and taken out of special measures.

The watchdog also rated Huntercombe’s Watcombe Hall specialist child and adolescent mental health hospital in Torquay “inadequate” and placed it in special measures in July last year. It was closed in August 2017.

Questions remain over medics’ pay increase

It is hard to see who the government’s announcement on doctors’ and dentists’ pay will make happy.

The 1.5 per cent pay rise for consultants, which will not be backdated and come in from October, is less than the 2 per cent recommended by the independent pay review body. The two unions representing consultants have slammed the announcement and the British Medical Association has even said it is considering its next steps.

Meanwhile, questions remain over who will foot the bill.

The other bit of significant news in Matt Hancock’s statement was a pledge to kick off wider negotiations on the consultants’ contract, to reach a multiyear settlement and a new system of performance related pay.

Hancock’s musings on NHS culture

After professing his unconditional love for the NHS, one of the first formal decisions taken under the new health and social care secretary’s watch was the announcement of a salary rise for doctors below the pay body’s recommendation.

The former culture secretary took little time to establish his three priorities. No, not technology, technology and technology, but prevention, workforce, and, you’ve guessed it, technology.

Mr Hancock confirmed that the government is planning to stockpile drugs for a no-deal Brexit and that he has “accelerated” the contingency planning process for which the costs could be significant.

He also set out in robust language his views on NHS’s management. 

He did however indicate that he might be less interventionist than Mr Hunt was in pushing for the sacking of chief executives of struggling trusts, as happened ahead of last winter.

England’s least keen STP?

It’s not unknown for clinical commissioning groups and trusts to have a grumble about sustainability and transformation partnerships behind the scenes but it is unusual for that negativity to spill over into any public arena.

Yet in Kent and Medway, three CCGs would not approve their STP contributions at the first attempt, citing a range of concerns around value for money, transparency and impact on the population.

(Worth noting that not everyone was up for a single accountable officer – Thanet and South Kent Coast CCGs were reluctant to accept a single AO across the county – but eventually relented)

There’s also a little bit of east/west rivalry in some of the issues raised. The STP’s involvement in East Kent, which is heading for public consultation on a very controversial but overdue reconfiguration, may mean less focus on the north and west of the county and other much needed projects.

Is fit and proper fit and proper?

Ever since they were introduced in November 2014, the fit and proper person regulations have been controversial. They have upset many managers who feel under attack for decisions and practices that are forced on them by the system they work in, while whistleblowers and harmed patients have complained the regulations have proven useless with not a single board level director being declared unfit and prevented from working.

Tom Kark QC was hired to look at the regulations. As lead counsel to the Mid Staffs Inquiry, he knows the issues well.

Mr Kark may decide to sweep it away and replace it with a proper system of regulation for NHS managers, as Sir Robert Francis QC recommended in his very first inquiry into Mid Staffs.

The final report is due in the autumn.

Long distance pathology

Ten months on from NHS Improvement’s statement of intent to establish 29 pathology networks across England, the programme is gathering pace.

The majority of trusts have agreed to be part of a network, some begrudgingly so, and the regulator has expanded the scheme to include specialist trusts.

But two acute trusts have been put on the naughty step over their refusal to sign up to NHSI’s plans.

East Sussex Healthcare Trust is determined to look north rather than its neighbours, and wants to form a network with three London trusts.

The other trust which is “in discussion” with the regulator is Epsom and St Helier University Hospitals Foundation Trust.

Alongside the networking agenda, NHSI is also drawing up a list of pathology tests, which could lead to the development of a tariff price for pathology in the long term.