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 man from the Treasury

You can take the man out of the Treasury, but not, it seems, vice versa.

In his first major intervention since becoming the finance director of NHS England/Improvement, former head of public spending at the Treasury Julian Kelly has written to trusts telling them to restrain their capital spending.

As the NHS tries to make the most of the year of relative financial plenty ahead of it to improve performance and deliver service change, long delayed or awaited capital projects have been included in trust plans. However, it appears they have read the runes poorly – now is not the time to get building.

Connor Ellis, a knowledgeable observer on the NHS’ use of capital, notes: “The irony is private sector capital (which is the only other option if real NHS capital becomes scarce) is virtually at an all-time low, [and] makes this a double whammy.”

Unfortunately, it is actually a triple whammy as Mr Kelly makes it clear he expects to be sending another letter soon, as “the current gap is sufficiently large that we suspect there will still be further work to do”.

Six-hour target

With NHS England set to trial replacement metrics for the four-hour accident and emergency target, the suggestion by the organisation’s emergency care clinical lead that there should be “zero tolerance” to patients spending longer than six hours in A&E was notable.

Cliff Mann told a King’s Fund conference he was “very keen on having a zero per cent tolerance of people being in an emergency department beyond six hours” because there were no clinical reasons for such a long wait.

He was also keen to stress that a “one size fits all” approach to A&E was no longer viable due to the large variation in case mix seen by different departments.

Goodbye Matthew, Hello Matthew

As predicted by HSJ, NHSE number two Matthew Swindells has departed. He left on the same day, the organisation advertised for its new chief operating officer. NHSE has also maintained its quota of Matthews by appointing Cambridgeshire Community Services Trust chief executive Matthew Winn as its first community services director.

Mega mergers

Merging clinical commissioning groups is no easy task, as the south east is discovering. There is rarely a neat solution which matches local authority areas and natural healthcare flows, as well as providing a sustainable framework for effective commissioning.

These issues are being played out in Sussex where seven CCGs are likely to be reorganised into three, dovetailing with the local authority boundaries in the area.

East Surrey CCG, meanwhile, is likely to join the Surrey Heartlands CCGs in an integrated care system. Something similar is happening in Kent and Medway where the eight CCGs are also mulling over a merger.

Both counties’ mergers have barriers still to overcome – GP acceptance and NHS England approval for a start. But the developments show both STPs are maturing and starting to make progress in sorting out commissioning arrangements.

Feeling miffed

At what point does a state-subsidised company gain an unfair advantage over private sector competitors?

That is the question which has prompted discussions between the Department of Health and Social Care and Bunzl Healthcare over the former’s establishment of the new NHS Supply Chain.

Several sources told HSJ Bunzl and other large private sector suppliers to the NHS are miffed because they are competing against a mainly taxpayer-funded company.

The DHSC could ultimately consider a legal challenge, if companies feel procurement law has been broken.

The people have spoken

More than 160,000 people have told NHS England via an online campaign survey that they want the law changed “so that contracts to run NHS services no longer have to be put up for auction”.

The submissions from 38 Degrees come as NHSE seeks to build pressure for politicians to support its proposed changes to legislation, which include seeking amendments to “free the NHS from overly rigid procurement requirements”. Views from within the health sector so far have been mixed.

However, NHSE is pleased with the level of engagement it has seen on the issue (it also discussed the proposals at the first meeting of the new “NHS Assembly” last month) but it’s yet to be seen how it will respod to the 38 Degrees camapaign.

Left in limbo

“Success has many fathers while failure is an orphan” is as true of the NHS as other walks of life – successes get talked about but organisations are often silent about problem areas.

This seems to be the case with the child and adolescent mental health services new model of care planned for Surrey, Sussex and Kent. NHSE announced a planned start date in 2017 which slipped to 2018 before the service was quietly shelved.

Cygnet Health Care, probably the biggest provider of inpatient CAMHS has closed one unit after quality concerns and has seen another heavily criticised. Priory Healthcare has also recently been fined over the death of a teenager in one of its units. While Elysium Healthcare has an adolescent eating disorders unit in Brighton, the remaining partner – Huntercombe Group – has no CAMHS inpatient services in Kent, Surrey and Sussex.

This may have limited the help private providers could have offered, but the planned partnership’s demise leaves services in Kent and Sussex in limbo with no real alternative to sending some young people out of area – especially from Kent.