News review - summer 2020

16 September 2020 Seamus Ward

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A lot has happened. The NHS wound down and is now ramping up ‘normal’ services. A new financial regime is in place. Practically all areas have been impacted. Auditors, for example, worried the pandemic would lead to fraud perpetrated against public bodies. The newly named Audit Wales (formerly the Wales Audit Office) said fraud against the public sector was a constant threat and the pandemic had ‘generated an explosion in fraudulent activities’. The UK’s first Covid-19 case was reported on 31 January and the first UK Covid fraud case recorded just nine days later, it added. However, the auditors heaped praise on NHS Wales, acknowledging it was leading the way among local public bodies.

Covid has thrown a spotlight onto social care – particularly how we look after our elderly and vulnerable in care homes – and to a lesser extent waiting times for hospital care. The many Covid victims dying in care homes prompted debates on funding and the future organisation of social care. The Health for Care Coalition, chaired by the NHS Confederation, told prime minister Boris Johnson a comprehensive and funded plan to support social care through the winter is needed or the NHS has no hope of clearing the backlog of routine operations. Patients would end up stranded in hospital without adequate provision in the community to care for them on discharge. The coalition urged the prime minister to honour his pledge to fix social care ‘once and for all’, and set out a reform timetable that met immediate needs and the need to put social care on a sustainable footing.

Health and care staffing has been one of the main themes running throughout the pandemic. The public showed their appreciation by clapping on Thursdays for all key workers, but, as some low-paid health and care staff pointed out, applause doesn’t put food on the table. Workers on Agenda for Change have a pay agreement that lasts until next March, but in July doctors were told they would receive a 2.8% pay rise backdated to April this year. The Department of Health and Social Care said the uplift was in line with the NHS long-term plan funding settlement. It is worth up to £3,000 for consultants in basic pay. The Welsh and Scottish governments have also implemented the increase.

The level of future pay rises will depend on the outcome of the comprehensive spending review, due in the autumn. The government will have to balance many competing interests, including the economic impact of Covid and Brexit, the ongoing financial impact on health and care, and the needs of other spending departments, such as education. The review will set government department resource budgets for 2021/22 to 2023/24 and capital budgets for the years 2021/22 until 2024/25. It will also cover devolved administrations’ block grants for the same period.

NR_WeAreTheNHS_Sept20_PBuilding on the Interim people plan published last year, We are the NHS: people plan 2020/21 – action for us all considers the learning from the impact of the Covid pandemic and the consolidation of good practice. The lack of a finalised comprehensive spending review meant the NHS could not set out a five-year funding strategy, but the publication looks at areas such as staff wellbeing and physical safety and health. It also looks at the impact of technology adopted during the pandemic and governance processes, while promising flexible working and encouraging former staff to return.

Four Welsh NHS bodies failed to meet their financial duty to break even over three years, according to Audit Wales. NHS Wales’ summarised accounts for 2019/20 said the four bodies had accumulated deficits of £354m over the past three years. Some progress had been made and the NHS Wales deficit had reduced from £96m in 2018/19 to £89m in 2019/20. The auditors said the financial statements were a true and fair reflection of the service’s finances.

Meanwhile, the Welsh government has published a mid-point evaluation of its A Healthier Wales transformation fund, examining its influence on the adoption of new ways of working before the Covid-19 outbreak. Launched in 2018, the £100m fund covers all seven regional partnership boards, which can bid for funding for programmes that would align health and social care services, focus on primary and community-based care delivery and develop integrated prevention services. The report recommends closing projects that are not working and giving more time to projects to capture the necessary evidence of impact. Reporting requirements for different but similar funding streams should be harmonised, it adds.

NR_NHSafterCovid_Sept20_PThe Covid pandemic shows the NHS needs a new financial strategy, with funding shifting to incentivising population health rather than organisational health, according to provider chief executives. They told the NHS Confederation it was unlikely the UK would emerge from the virus soon, so a new approach to finances was needed. A confederation report, The NHS after Covid-19: the views of provider trust chief executives, said national funding changes in response to the pandemic, such as the introduction of block contracts, were largely positive. But there was concern that the measures were short term and did not deal with the underlying financial challenges facing trusts. Chief executives welcomed the reduction in transactions following the introduction of block contracts, but feared the NHS would revert to previous arrangements.

The Commons Health and Social Care Committee is to trial Care Quality Commission-style ratings for ministers and national NHS bodies such as NHS England and NHS Improvement. Independent panels will look at four questions on progress with policy pledges – has the commitment been met or is it on track to be met; has it been effectively funded; did it achieve a positive impact for patients; and was the commitment appropriate? An initial pilot will examine progress against maternity targets.

The annual cost of harm from clinical activity under the clinical negligence scheme for trusts (CNST) fell from £8.8bn in 2018/19 to £8.3bn in 2019/20. In its annual report, NHS Resolution said provisions increased by £700m to £84.1bn. Maternity remained the highest value area for claims settlement, representing 50% of the total value of all clinical negligence claims received, 69% of the incurred cost of harm and 72% of the total CNST provision. The report includes the first year of the clinical negligence scheme for general practice, and describes the rapid launch of the clinical negligence scheme for coronavirus.



‘This year tens of thousands of healthcare workers have faced probably the most stressful period of their careers, with many putting their lives at risk and worse, but they’re not being recognised for it.’

BMA council chair Chaand Nagpaul says pay awards for 2020/21 are not enough to thank doctors for their work during the Covid crisis and years of underpayment

‘The pandemic has placed enormous pressure on colleagues. It has been encouraging to see remote mediations taking place so that cases can continue to be resolved without added stress to patients and those who care for them.’

NHS Resolution chief executive Helen Vernon sees the mediation process adapting under Covid-19

‘This will mean the government is held to account by an evaluation process similar to that used across the NHS and social care system, which gives not just an absolute score but key pointers as to how to improve that score next time round.’

Commons Health and Social Care Committee chair Jeremy Hunt says its new rating system aims to focus minds on areas such as cancer


‘Every person working in the NHS has contributed to an unprecedented national effort to beat back this virus and save lives. They have protected us and, in return, this government will do everything in its power to protect and support them.’

Health and social care secretary Matt Hancock backs the latest iteration of the NHS people plan


From the HFMA

Despite the restrictions placed by Covid-19, the HFMA has continued to support and inform members in a number of different ways. The series of HFMAtalk podcasts, launched at the start of the year, was expanded and made more regular just after the lockdown was announced at the end of March. Sanjay Agrawal, HFMA trustee and consultant in respiratory medicine and intensive care at University Hospitals of Leicester NHS Trust, gave a clinical perspective of the impact of Covid in a series of podcasts. Others looked at different regions and countries of the UK, as well as sectors of the NHS.

HFMA president Caroline Clarke appeared on the podcasts and as a regular blogger. In the latter, she has covered a wide range of subjects, including the need to put an end to racism; the finance staff role in the pandemic response; and the importance of systems in bringing services back to pre-Covid levels.

King’s College Hospital gastroenterology and general medical registrar Aamir Saifuddin gave a two-part account of the stresses at the front line and the lessons he has learnt, while NHS Nightingale Hospital London director of finance Rob Clarke took us inside the first NHS Covid field hospital.

Other blogs looked at the impact of Covid on charities and the ever-present need for a consistent supply of personal protective equipment (PPE). Bill Shields, former NHS finance director and now chief financial officer at Bermuda Hospitals Board, also had PPE on his mind in his lockdown diary, which reports his own experience of quarantine and self-isolation, as well as how the territory is responding to the pandemic.

See the HFMA website for more blogs and podcasts for more. Episodes of HFMAtalk can be found on the HFMA website or via podcast apps.