Essential insight into England’s biggest health economy, by Ben Clover

Barts bashing?

What are we to make of the fact that Barts Health, and some other troubled trusts, pay a 6 per cent rate of interest on some of their loans from the Department of Health?

That they are being “kicked when they’re down”? Possibly.

That it’s a good thing these trusts are mostly not foundation trusts, who could get a better rate than 6 per cent elsewhere? Yes. What isn’t more interesting with HM Treasury involvement?

No one seriously expects this money to be paid back anyway, and Barts also pays a hefty unitary payment on its shiny Royal London Hospital building.

So what’s the point?

Sure, you could argue it makes things very uncomfortable for the trust’s accountants.

But they were uncomfortable anyway and some would say they have done a heroic job in keeping the forecast outturn deficit at Barts to £83m. This is less than 1 per cent of turnover and, more importantly, on plan.

It’s the Royal Free, St George’s and King’s that are giving the central bean counters headaches with their sudden deteriorations.

Barts was also placed in financial special measures in the financial reset of last July.

It’s hard to say what further measures could be applied to the organisation to tell it: “You are spending too much money.”

(I bet it is glad it took the sustainability and transformation fund bailout money, considering NHS England has effectively confirmed this week trusts won’t get fined for Referral to Treatment and cancer target breaches. Getting fined by commissioners was a major bugbear for Barts).

Whenever there are serious problems at Barts it is tempting to ponder whether its creation was a mistake.

Have Whipps Cross, Newham, and Barts and the London done any better than they would have done as separate trusts?

What meaningful financial regulatory action can be taken at the £1.1bn turnover trust by outside forces? Putting it in more debt simply puts it in more debt.

A new chair for the trust was announced this week – what can he do differently from his predecessor?