News Review - February 2019
The National Audit Office expressed ‘shock’ at the number of local bodies, including those in the NHS, that have received qualified audit reports. These qualifications reflected weaknesses in arrangements to secure value for money and not problems with financial statements, which were unqualified for the third year running. The value-for-money qualifications – issued to 168 (38%) of NHS bodies in 2017/18 compared with 130 (29%) in 2015/16 – were mainly the result of not meeting financial targets such as staying within spending limits, delivering savings or inadequate plans to deliver balance. The NAO’s report added that 39% of clinical commissioning groups received a qualified opinion on the regularity of their 2017/18 financial statements because they had spent more than their allocations.
In a separate report, the NAO said many CCGs are performing well and within budget, but others are failing to function effectively or hire and retain the high-quality staff they need. A review of the role and costs of clinical commissioning groups noted that an increasing number of CCGs are overspending against their total budget plan. In 2017/18, 75 of 207 CCGs spent more than planned, with a total overspend of £213m across all CCGs. This compares with 57 CCGs in 2016/17 and 56 in 2015/16. However, CCGs have consistently spent less than their running costs funding, which fell from £1.35bn in 2013/14 to £1.21bn in 2015/16. It is planned that running cost allocations will reduce by a further 20% by 2020/21.
Patients fail to turn up to one in 20 primary care appointments, costing the NHS more than £200m a year and wasting more than 1.2 million GP hours, according to NHS England. It said more than 15 million appointments are missed each year, with patients not attending or failing to tell surgeries they will not be attending in time to reallocate the appointment. Around half of the missed appointments are with GPs – with each appointment costing an average of £30, failure to attend costs more than £216m. The national body urged patients to let surgeries know in good time if they are not able to attend.
A review of the GP partnership model recommended that funding for GP training places be increased, with a more positive focus given to general practice as a career choice during medical training. The review also recommended a reduction in personal risk and liability associated with GP partnership and called for a wider range of healthcare professionals to be embedded in practices to offer services in the community.
The Scottish government has proposed increases in health and care funding in 2019/20. In its Budget, it said it would use additional tax revenues, promised by the government in Westminster, to mitigate a £55m shortfall in NHS funding. Overall funding for revenue will be £13.9bn. The Budget document said frontline NHS board funding would increase by 4.2%. The Budget confirmed public sector pay would rise by 3% for those earning up to £36,500, while direct investment in mental healthcare would increase by £27m, taking overall funding of the sector to £1.1bn. It would also increase funding to health and social care partnerships to more than £9bn for delivery of primary and community health services.
In Wales, health board allocations for 2019/20 were announced. Health board discretionary allocations have increased by 2% (£92m) to meet estimated pay costs and other inflationary pressures. As in 2018/19, there will be a number of top slices to fund specific developments, with funding transferred to ring-fenced allocations or held centrally. An extra £45m has been added to the discretionary allocation to develop stronger integrated medium-term plans to take forward the strategy, A healthier Wales – this funding should be used to invest in primary care; embed value-based healthcare; take forward major strategic decisions; and improve quality.
Julian Kelly has been appointed NHS chief financial officer in the new joint NHS England and NHS Improvement senior leadership team. The joint group will be known as the NHS Executive Group and will be led by Simon Stevens and Ian Dalton. Mr Kelly will join the group from the Defence Nuclear Organisation at the Ministry of Defence, where he is director general nuclear. A chartered accountant with CIMA membership, he has also held senior roles in the UK Border Agency and HSBC. NHS Improvement chief financial officer Elizabeth O’Mahony is to become South West regional director. NHS Improvement announced a number of departures, including Adam Sewell-Jones, its executive director of improvement, and Stephen Hay, executive director of regulation and deputy chief executive. The departing executives will remain in post until the end of March, unless explicitly agreed otherwise.
Former NHS Improvement chief executive Jim Mackey – who is currently chief executive of Northumbria Healthcare NHS Foundation Trust and a former NHS finance director – was knighted for services to health in the new year’s honours list. There were OBEs for HFMA Clinician of the Year in 2012 Malik Ramadhan, a consultant and divisional director in emergency care at Barts Health NHS Trust, and Angela Walsh, head of NHS pay at the Department of Health and Social Care.
The latest monthly performance figures for the NHS in England continue to show waiting time targets being missed in the face of mounting demand. In November 2018, 87.3% of patients had been waiting fewer than 18 weeks for elective treatment – it was 89.5% a year earlier – failing to meet the 92% target. However, the number of completed pathways increased by 0.4% over the 12-month period. In A&E, demand was 3.6% higher in the year to December than in the preceding 12 months. Data shows that 86.4% of patients were admitted, transferred or discharged within four hours, missing the 95% target.
NHS England and NHS Improvement have published the 2019/20 national tariff for its statutory consultation. The document confirms changes proposed towards the end of last year, including setting the tariff for a single year. A new blended payment system will become the default approach for emergency care, supported by a £1bn transfer from the Provider Sustainability Fund into emergency care prices. Prices will also be subject to a revised market forces factor, with the new MFF values phased in over five years. New procurement arrangements will be supported by a topslice to the tariff quantum
In a separate report, the NAO said many CCGs are performing well and within budget, but others are failing to function effectively or hire and retain the high-quality staff they need. A review of the role and costs of clinical commissioning groups noted that an increasing number of CCGs are overspending against their total budget plan. In 2017/18, 75 of 207 CCGs spent more than planned, with a total overspend of £213m across all CCGs. This compares with 57 CCGs in 2016/17 and 56 in 2015/16. However, CCGs have consistently spent less than their running costs funding, which fell from £1.35bn in 2013/14 to £1.21bn in 2015/16. It is planned that running cost allocations will reduce by a further 20% by 2020/21.Patients fail to turn up to one in 20 primary care appointments, costing the NHS more than £200m a year and wasting more than 1.2 million GP hours, according to NHS England. It said more than 15 million appointments are missed each year, with patients not attending or failing to tell surgeries they will not be attending in time to reallocate the appointment. Around half of the missed appointments are with GPs – with each appointment costing an average of £30, failure to attend costs more than £216m. The national body urged patients to let surgeries know in good time if they are not able to attend.
A review of the GP partnership model recommended that funding for GP training places be increased, with a more positive focus given to general practice as a career choice during medical training. The review also recommended a reduction in personal risk and liability associated with GP partnership and called for a wider range of healthcare professionals to be embedded in practices to offer services in the community.
The Scottish government has proposed increases in health and care funding in 2019/20. In its Budget, it said it would use additional tax revenues, promised by the government in Westminster, to mitigate a £55m shortfall in NHS funding. Overall funding for revenue will be £13.9bn. The Budget document said frontline NHS board funding would increase by 4.2%. The Budget confirmed public sector pay would rise by 3% for those earning up to £36,500, while direct investment in mental healthcare would increase by £27m, taking overall funding of the sector to £1.1bn. It would also increase funding to health and social care partnerships to more than £9bn for delivery of primary and community health services.
In Wales, health board allocations for 2019/20 were announced. Health board discretionary allocations have increased by 2% (£92m) to meet estimated pay costs and other inflationary pressures. As in 2018/19, there will be a number of top slices to fund specific developments, with funding transferred to ring-fenced allocations or held centrally. An extra £45m has been added to the discretionary allocation to develop stronger integrated medium-term plans to take forward the strategy, A healthier Wales – this funding should be used to invest in primary care; embed value-based healthcare; take forward major strategic decisions; and improve quality.
Julian Kelly has been appointed NHS chief financial officer in the new joint NHS England and NHS Improvement senior leadership team. The joint group will be known as the NHS Executive Group and will be led by Simon Stevens and Ian Dalton. Mr Kelly will join the group from the Defence Nuclear Organisation at the Ministry of Defence, where he is director general nuclear. A chartered accountant with CIMA membership, he has also held senior roles in the UK Border Agency and HSBC. NHS Improvement chief financial officer Elizabeth O’Mahony is to become South West regional director. NHS Improvement announced a number of departures, including Adam Sewell-Jones, its executive director of improvement, and Stephen Hay, executive director of regulation and deputy chief executive. The departing executives will remain in post until the end of March, unless explicitly agreed otherwise.
Former NHS Improvement chief executive Jim Mackey – who is currently chief executive of Northumbria Healthcare NHS Foundation Trust and a former NHS finance director – was knighted for services to health in the new year’s honours list. There were OBEs for HFMA Clinician of the Year in 2012 Malik Ramadhan, a consultant and divisional director in emergency care at Barts Health NHS Trust, and Angela Walsh, head of NHS pay at the Department of Health and Social Care.
The latest monthly performance figures for the NHS in England continue to show waiting time targets being missed in the face of mounting demand. In November 2018, 87.3% of patients had been waiting fewer than 18 weeks for elective treatment – it was 89.5% a year earlier – failing to meet the 92% target. However, the number of completed pathways increased by 0.4% over the 12-month period. In A&E, demand was 3.6% higher in the year to December than in the preceding 12 months. Data shows that 86.4% of patients were admitted, transferred or discharged within four hours, missing the 95% target.
NHS England and NHS Improvement have published the 2019/20 national tariff for its statutory consultation. The document confirms changes proposed towards the end of last year, including setting the tariff for a single year. A new blended payment system will become the default approach for emergency care, supported by a £1bn transfer from the Provider Sustainability Fund into emergency care prices. Prices will also be subject to a revised market forces factor, with the new MFF values phased in over five years. New procurement arrangements will be supported by a topslice to the tariff quantum
Quotes
‘Our message is clear: if you cannot make it to your appointment or no longer need a consultation, please let your GP practice know in advance, so the appointment can be filled by another patient.’
Nikki Kanani, NHS England acting primary care director, makes a plea for patients to be considerate
‘We’re still in the early days of winter, and pressures are likely to increase further if cold weather or viral illnesses hit in earnest. If these pressures were to hit, this would make it harder for the service to improve performance and start implementing the long-term plan from April.’
Health Foundation policy fellow and GP Becks Fisher warns winter pressures could still impact on the NHS plan
‘This award represents the hard work and dedication of colleagues in the trust who, day-in day-out, deliver fantastic patient care. I’d also take this opportunity to pay tribute to those staff I worked closely with in NHS Improvement and thank them, and all colleagues at Northumbria Healthcare, for their support and I accept this award in their collective honour.’
Jim Mackey accepts his knighthood
‘I am shocked by the persistent high level of qualified audit reports at local public bodies. A qualification is a judgement that something is seriously wrong, but despite these continued warnings the number of bodies receiving qualifications is trending upwards.’
NAO head Amyas Morse is stunned by the number of value-for-money qualifications on audit reportsRelated content
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