Reality bites as the NHS meets its 'reset moment'

While the post-referendum political circus rolls on, the national NHS leadership is seeking to shift the focus back to reality with a jolt. A stark reminder of the service’s financial challenge for the next couple of years will come this week, in a series of high profile national interventions billed as a “reset moment”.

The context of this reset was partly contained within the diktat sent to finance directors last Thursday finalising terms of access to the £1.8bn sustainability and transformation fund. This mechanism is intended to give the centre a tight grip on delivery through the year.

No trust will receive anything if it is not on track to meet its financial control total – ambitious targets about which many providers have serious reservations. A trust that is on track financially can still lose up to 30 per cent of its STF if it’s not up to scratch against the big three waiting targets: accident and emergency, elective and cancer.

NHS chiefs will be made to understand the clear “consequences of failure” for those trusts judged to be most seriously letting the side down on overspending or A&E performance

The above – in particular the money and A&E – are more or less set in stone as the NHS’s top priorities this year, regardless of change in prime minister or government.

The letter also confirms HM Treasury still has its claws firmly dug into the NHS. Number 11 will be reviewing the STF on a rolling basis, it makes clear.

The reset will build on the intervention at the end of last month by NHS Improvement chief executive Jim Mackey, who in an understated letter kicked off what may become the biggest direct national intervention in the running of NHS providers since the birth of foundation trusts.

Controversial decisions

It will require a group of 20-30 trusts which had been planning wage bill growth of £400m this year to revisit them. There will also be a rapid move to huge consolidation across pathology, back office and locum-dependent elective services.

NHS chiefs will be made to understand the clear “consequences of failure” – over and above the loss of STF funding – for those trusts judged to be most seriously letting the side down on overspending or A&E performance.

There will be a remorselessly harsh focus on around 40-50 trusts which are persistently failing in one or both of these areas.

But these are not the only big moves being made by the central bodies amid the post-referendum political vacuum. Friday saw NHS England launch its latest proposals for centralisation of congenital heart disease surgery, with three trusts put on notice to stop.

This may give NHS leaders reassurance such difficult and controversial decisions can and should be made, and will be backed at the top, despite the current political turmoil.

However, it is also concerning that, despite a review process that most acknowledged was significantly more robust than past attempts, the proposals met immediate and uncompromising challenge from those facing the loss of services.

Finally, recent days have seen the Care.data programme formally put out of its misery, new data sharing proposals put forward by Dame Fiona Caldicott, and three new senior appointments to bolster NHS England’s efforts on technology.

By far the most notable among these was Keith McNeil as chief clinical information officer, an appointment which comes less than a year after Dr McNeil left his chief executive post at Cambridge University Hospitals, following a turbulent tech implementation and an “inadequate” rating from the Care Quality Commission.

Given the sharp rebuke which Dr McNeil delivered to the regulatory system at the time, his appointment by NHS England is a bold decision which will not please some senior figures.

It also sends a message which will need to be reiterated often throughout the coming months of noisy browbeating over money and performance: big changes take time, sometimes go wrong, but will also be supported.