Technical / Technical review - September

The Charity Commission consulted over the summer on a new approach to the annual return that charities are required to submit, including a new set of questions to obtain additional data. The HFMA has made a number of suggestions. It agreed with a proposal to increase flexibility in the return, but was unsure about the impact of questions in the consultation, spanning a range of areas, including financial governance, charity operations and structure, and employees and volunteers.

Nearly £15m of public sector fraud was detected by the 2020/21 national fraud initiative (NFI) exercise in Scotland. The outcomes identified by the exercise, which involved 132 Scottish bodies including NHS organisations, were £0.4m lower than two years ago. Audit Scotland said this could be as a result of stronger internal controls in public bodies, the omission of some key datasets this time around or because staff had less time to commit to the programme during the pandemic. Outcomes include the overall amounts of fraud, overpayments and an estimate of future losses prevented.

Almost a quarter of the Department of Health and Social Care’s spending in 2020/21 was related to Covid-19, according to a National Audit Office review of the Department. This included:

• £13.5bn for NHS Test and Trace
• £13.1bn on the procurement and supply of personal protective equipment
• £16.3bn on the NHS Covid response
• £3.6bn on other Covid-related activities.

In total, the Department spent £193.4bn during the year, with £146bn accounted for by NHS England. Some £6.5bn was passed to local authorities, both directly and via Public Health England – although this does not include funding channelled through the better care fund, which is administered by NHS England. The £4.4bn spent by Health Education England included:

• £2.1bn on postgraduate training
• £0.9bn on undergraduate training
• £0.7bn on clinical education and training.

The report also highlights the most significant challenges facing the NHS, which include: workforce shortages and strain; digitising the NHS; and restructuring related to the Health and Care Act.

The HFMA VAT Committee has published a document on issues to consider when reclaiming VAT on contracted-out services (COS) heading 71 (welfare services). The heading covers services including staff support, staff counselling, and care, treatment or instruction to improve physical or mental wellbeing. The committee discussed two issues at recent meetings – the meaning of the statement on supplies to prison inmates and hospital inpatients, and contract novation by care homes. It identifies questions and concerns, and aims to raise the profile of the issues.

The Department of Health and Social Care has confirmed that NHS Resolution will operate the Existing Liabilities Scheme for General Practice (ELSGP) on a permanent basis. The arm’s-length body already operates the Clinical Negligence Scheme for General Practice (CNSGP). Both schemes were launched in April 2019, with NHS Resolution running the ELSGP on an interim basis. Historical clinical negligence claims made against general practice staff come under the scope of the ELSGP, while the CNSGP covers liabilities incurred from 1 April 2019. A Department statement said: ‘The economies of scale associated with operating multiple schemes support our assessment that NHS Resolution’s management of the two GP indemnity schemes will deliver efficiency and value for money.’

NHS England published guidance in August to support the collection of patient-level costs for a group of further services. Until now, chemotherapy, radiotherapy, renal dialysis, specialist rehabilitation, specialist palliative care and community midwifery have been collected at average cost per unit in the national cost collection workbook. However, as part of the costing transformation programme, a pilot is being run this year to test the collection of these services at patient level. The guidance, published on the NHS England costing team’s open learning platform, said that data from the collection will only be used to review the collection structure and make improvements for future years. It will not be used to develop pricing or currencies.

The NHS oversight framework has been updated to reflect the formal launch of integrated care boards (ICBs) on 1 July. The amended framework has six themes, one of which relates to finance and use of resources. There are four metrics in the finance theme, and two apply to both ICBs and provider trusts – financial efficiency (variance from the efficiency plan) and financial stability (variance from break-even). Systems will also be assessed against the mental health investment standard and agency spending. Based on assessment against metrics in all six themes, ICBs and trusts will be put into one of four segments, reflecting the level of support they need. They will range from segment 1 (no specific need) to segment 4 (mandated intensive support). System agency ceilings have been set for agency spending based on the spending levels included in provider financial planning returns for the year.