News review - July 2019

03 July 2019

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Starting in Westminster, fresh from his own failed prime ministerial bid, health andMatt Hancock social care secretary Matt Hancock was called to appear before the Commons Health and Social Care Committee. The committee had asked Mr Hancock for a copy of the government review of NHS overseas visitor charging, and its evidence. However, the health secretary turned down the request twice, insisting that he was unable to publish the review as some information was provided on a confidential basis. This led to his invitation to appear before the committee to explain himself. But the health secretary was unavailable, sending health minister Stephen Hammond and permanent secretary Chris Wormald in his place.

Separately, Mr Hancock confirmed to the committee that he will publish a consultation on patient registration, funding and contracting rules around digital first primary care. He said rapid growth in list size for a digital first GP service can lead to financial pressures. The baseline funding of Hammersmith and Fulham Clinical Commissioning Group – where the GP at Hand online service is based – was increased from the start of 2019/20, taking account of the list growth during 2018/19. A mechanism will be introduced to transfer funding between CCGs during 2019/20 to take account of the financial impact on the CCG of new patient registrations during the current financial year, he added.

A further three integrated care systems (ICSs) were given the green light by NHS England. The North East and Cumbria ICS will become the country’s largest, serving more than three million people. The other new ICSs are: South East London; and Buckinghamshire, Oxfordshire and Berkshire West. There are now 15 ICSs, plus two devolved systems in Greater Manchester and Surrey, in total covering one in three people in England. NHS England has also published a guide to setting up an ICS. The paper sets out the different levels of management, describes their core functions, the rationale behind them and how they will work together.

NHS Emp ReportAbout a third of employers think pension charges for high earners will affect a relatively large group of their employees. An NHS Employers survey said employers were concerned about the impact on retention and staff reducing hours or not taking on extra work. An employee survey showed many were considering taking these actions, as well as early retirement, to reduce their exposure to potential pension tax charges. The survey also cited a lack of understanding of pension allowances, with employers saying more HR time and resources were allocated to queries and complaints.

Cuts to the public health budget of £1bn in real terms must be reversed, said the Health Foundation and the King’s Fund. With the government spending review likely to be delayed or limited due to Brexit uncertainty, ministers cannot keep putting off decisions on public health funding, the charities said. Ministers must signal their intention to restore spending to previous levels and ensure there are no further reductions. Cuts made since 2015/16 are having a major impact on services and undermine attempts to influence wider determinants of health, such as housing and transport, they said.

A government review confirmed that local authorities will continue to commission public health services, but NHS bodies will be given a greater say in decision-making. The Department of Health and Social Care review concluded that councils should work more closely with the NHS to co-commission services such as sexual and reproductive healthcare. The review, promised as part of the NHS long-term plan, added that more integrated commissioning would embed prevention in a wider range of services.


Healthier WalesThe Welsh government announced it has allocated more than 80% of the £100m transformation fund it set up to change the way health and social care services are delivered. Announcing that Cwm Taf Regional Partnership Board would receive £22.7m from the fund, health minister Vaughan Gething said more than £80m had now been distributed to back projects that can eventually be scaled up to deliver the aims of its long-term plan, A healthier Wales.  

The NHS Counter Fraud Authority (CFA) has set out its priority action areas for 2019/20. They include tackling frauds in areas such as pharmaceutical contractors, procurement and contractors in general practice. It also pledged to detect £22m of fraud, prevent a further £100m of fraud and recover £5m from losses due to fraudulent activity against the NHS.

NHS boards in England are less diverse than they were 15 years ago, prompting the NHS Confederation to call for a review of the appointment process for chairs and non-executive directors. A confederation report said fewer women and people of black and minority ethnic backgrounds were in the posts. The proportion of BME chairs and non-execs has almost halved since 2010 (from 15% to 8%), while that of female office holders has fallen from 47% in 2002 to 38% now.

NHS Providers warned that the service must not draw false comfort from the lack of winter pressures stories in the media. Its briefing, The real story of winter, argues that the nation was preoccupied with Brexit. And, though trusts did make improvements, performance data showed a growing gap between demand and capacity.

Malcolm Wright has been appointed chief executive of NHS Scotland and director general of health and social care at the Scottish government. Mr Wright has been in the role on an interim basis since February and was appointed following an open competition. Starting as an administrative trainee at Lothian Health Board in 1975, he has worked across Scotland’s health boards and also served as a hospital manager at Great Ormond Street Hospital in London.

Amanda PrichardThe top team continues to take shape at the reformed NHS England and NHS Improvement. Amanda Pritchard was named NHS chief operating officer and chief executive of NHS Improvement. She is currently chief executive of Guy’s and St Thomas’ NHS Foundation Trust and will take up her new post on 31 July. In her chief operating officer post she will be accountable to chief executive Simon Stevens.

QUOTES

‘We must ensure that the way we commission and pay for care keeps up with the opportunities digital innovation offers, so that the system is not unduly destabilised by new service models.’

Transformation of GP services is at the front of health secretary Matt Hancock’s mind

Simon Stevens

‘We must keep a laser focus on making services as convenient as possible –everyone should feel like they are dealing with one system instead of having to repeat their story to a series of different organisations.’

Announcing three new ICSs, Simon Stevens says collaboration is the key to delivering the aims of the long-term plan

Duncan Selbie

‘This review recognises that local government are best placed to lead on commissioning local public health services and the invaluable skill and expertise they bring to this. The best services are always those commissioned collaboratively with the NHS and this review emphasises the importance of this for every part of England.’

Councils should lead but collaborate when commissioning services, says Public Health England CEO Duncan Selbie

‘To meet the demands of the future, we need to radically change the way services are delivered. We need to move away from healthcare that focuses on treating people when they become unwell to one that supports people to stay well, lead healthier lifestyles and live independently for as long as possible.’

Healthcare must become more proactive, says Welsh health secretary Vaughan Gething

From the HFMA

Matthew Cripps

The HFMA published a range of blogs in June. NHS England director of sustainable healthcare Matthew Cripps argues that systems must lead value improvement efforts. While individual organisations must focus on value, it is only by combining efforts that value is maximised at population level, he says. Data is vital – showing where to look, helping monitor progress and informing evaluation.

Staying at system level, HFMA Scotland Branch chair Derek Lindsay highlights the belief of the Scottish government and Audit Scotland that the pace of integration of health and social care must quicken. A new HFMA briefing, Planning for health in Scotland – a regional approach, looks at the elements needed for productive integration and gives an insight into regional planning.

In a separate blog, MIAA senior audit manager Sarah Dowbekin says getting the right governance can ensure organisations deliver their own and their partnerships’ objectives. The governance arrangements needed for partnership are demonstrated in a new HFMA briefing, Case studies from the HFMA Governance Award 2018.

Greater integration of services requires new payment systems. Lee Rowland, HFMA Payment Systems and Specialised Commissioning Committee chair, reminds NHS finance staff that payment systems are still in transition. Finance staff must remain involved in their development, he adds.

In his latest update from Bermuda, Bill Shields contemplates the early arrival of hurricane season and a new funding model introduced on 1 June.

www.hfma.org.uk/news/blogs