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.
The £700m IT shadow
When the Department of Health and Social Care terminated Fujitsu’s £900m contract to digitise a chunk of the NHS in 2008, no one expected they would still be arguing a decade later.
The dispute has cost the department tens of millions of pounds in legal fees alone, and deadlines for resolution have come and gone with the years.
HSJ revealed that the end is finally in sight, with the department and Fujitsu reaching an agreement on the terms of settlement.
The collapse of the Fujitsu contract is only one of the many expensive failures from the £10bn National Programme for IT, once described as “one of the worst and most expensive contracting fiascos in the history of the public sector”.
As the Fujitsu case demonstrates, there are lessons for which we are still paying the bill.
The Department of Health and Social Care has agreed to pay the company a large sum (it’s already paid some). HSJ has been told the figure is in the ballpark of the £700m Fujitsu originally sought.
Town hall takeover
The town hall takeover of NHS commissioning continues in Greater Manchester, where the chief executive of Bury Council is set to take over the reins of the borough’s clinical commissioning group.
Stuart North, Bury CCG’s accountable officer, is due to retire at the end of September, and is set to be replaced by Geoff Little, the council’s chief executive, who will perform both roles.
The proposed shared leadership model will mirror those in place in several other boroughs in the region.
With the future of NHS commissioning very much up in the air, national leaders will be paying close attention to developments in Greater Manchester, to see if the council-led model has legs.
Two-tier fear at subsidiaries
Transferring staff into a subsidiary company is a risky business.
Staff at East Kent Hospitals University Foundation Trust are going on strike in protest at being transferred, while staff at York Teaching Hospitals FT are also being balloted on industrial action.
Elsewhere in the country we have seen a local authority offering to pay the difference to the trust if it agreed to instead keep the staff in-house, while in the east Midlands a trust was effectively told to shelve its plan to transfer staff because Matt Hancock was unlikely to approve it.
No wonder the centre has signalled a desire to get a grip on the process, especially when, if unchecked, it could be a VAT issue for the Treasury and infuriate unions.
A good week for candour
Its been a good week for candour. NHS Improvement finally admitted reality on provider deficits and the government’s pick for NHS England chair was pretty blunt on what has to change (see below).
In its first quarterly report of 2018-19, NHSI admits the provider sector is carrying an underlying deficit of around £4.3bn, once the non-recurrent “provider sustainability fund” is discounted.
HSJ first highlighted the underlying deficit two years ago, following analysis by the Nuffield Trust think tank.
The DHSC has previously dismissed the warnings, saying “we do not recognise these claims”, while regulators have never acknowledged the situation publicly before (privately they did). What prompted this sudden outbreak of straightforwardness is not known.
Prior on changing provider psychology
A lot of the NHS’s legislation, policy and financial incentives are antithetical to delivering integrated care and system working.
So the NHS England chair pre-appointment hearing with the Commons health committee was too good an opportunity to miss for the government’s nominee, Lord David Prior.
He made it clear that, in his current role as a foundation trust chair (University College London Hospitals), he would have received no thanks or credit from its main regulators – NHS Improvement and the Care Quality Commission – for reaching beyond its statutory duties: ie, trying to help with “the system”.
This means that if providers are to stop acting as “islands in the sea” - instead working to help their populations, neighbours, and wider patches - there is a need for “very, very fundamental” changes across the board.
Whether this translates into changes to the borad of NHS England remains to be seen.
In May, the secretary of state stood up in Parliament and apologised. He said the national breast cancer screening programme had lost track of anything up to 450,000 women who were never called for their final test. Apparently an algorithm had gone askew, affecting the computer systems used to invite women to be screened.
But it now seems that conclusion was premature. A report by management consultants PwC for Public Health England says a misunderstanding was responsible for the incident, along with weak governance and loss of “corporate memory”.
Because few people at PHE had a granular knowledge of the programme, senior management did not realise their alarm at an apparent system failure was based on a misunderstanding, not a fault.
Five tests for 10 years
NHS Providers launched its latest lobbying effort on the long term plan, setting out five tests around focus and deliverability.
- be centred around patients and their carers;
- be realistic and deliverable;
- be underpinned by a credible workforce strategy;
- lay the groundwork for a sustainable high performing service; and
- support local good governance, autonomy and accountability.
The tests appear fairly motherhood and apple pie on first read. But considered in the broader context of recent NHS policy formation they are a good benchmark to gauge the new plan on.