HSJ’s roundup of the day’s essential health stories and debate

Today’s must know: Consultancies in the hunt for £1m contract to design NHS Improvement

Today’s talking point: “Huntism” dissected

Today’s plug: Watch - How will NHS Improvement affect regulation?

Who wants to be a millionaire?

The creation of NHS Improvement was always going to be a complex task, and as HSJ reported on Tuesday, the consultancy carrying out the job should soon be revealed.

The project will look at everything from “culture” to “assessing quality, finances and sustainability” in jamming parts of Monitor, the NHS Trust Development Authority and NHS England together.

The bid document, obtained by HSJ, is heavy on talk of culture, which contacts said was no surprise given the “polar opposite” natures of the TDA and Monitor.

Current employees might have cause to fear the “leadership development interventions” that could also be asked of a successful bidder.

The was a surprise omission: Monitor’s competition role is not mentioned at all.

And a surprise inclusion: applications for foundation trust status were mentioned – a policy you don’t hear much positive about these days.

The successful bidder will work alongside an “integration director” leading an “internal programme management office” of 15-20 people. The identity of this director is not known, but organogram fans can expect a draft organisation structure before Christmas and a final one early in 2016.

HSJ understands the contract is worth more than £1m, which has angered some HSJ readers - since June trusts have had to go to a Monitor run committee to get approval for consultancy spend above £50,000.

The story has provoked a lot of comment along the lines of “an outrage to spend this much designing NHS Improvement when trusts are banned [sic] from consultancy”.

The big four consultancies have been hurt by the cap, as you might expect, and will be keen to win this lucrative gig.

The Hunt equation

HSJ senior correspondent David Williams has been musing aloud on Twitter about the Jeremy Hunt’s developing approach to the health service, dubbed “Huntism”, triggered by reading a King’s Fund blog about the cost of safe staffing (spoiler alert: the KF suggests safe staffing tends to lead to increased costs).

Mr Hunt’s big theme as health secretary has been that safer care and lower costs are two sides of the same coin. Williams argues his first 2-3 years in post were about the first part of his “safe care = lower cost” equation. The next phase will have to be about the second part, without “knackering” the earlier work on safety.

Because of the focus on safety prior to the election, Williams went on, Mr Hunt would have been seen as broadly successful on his own terms, with the NHS taking action on safety and being (arguably, just about) solvent.

While this worked well enough before 7 May, the problem he now has is that sorting out the money will involve urgently cutting costs – rather than doing so transformationally, over a period of many years. Although a long term focus on safety could yield a better value service, quick cost cuts seem less likely to leave the NHS safer. This leaves the “Hunt equation (safe = cheap) looking untenable”, HSJ’s expert said.

Williams concludes: “Maybe if ‘make the NHS safe to make it cheaper’ had been adopted in 2010 we would have trained enough nurses by now to not need agencies.” And so safer staffing levels might have been more affordable.

Unfortunately, the NHS was given other priorities at the beginning of the last Parliament.

Happily, Mr Hunt is giving the HSJ Annual Lecture on Thursday (follow HSJ Live on the day for coverage), where he should have something to say about all this.