News review - September 2018

For now, the traditional drop in emergency activity over the summer months in England is a thing of the past, with demand remaining high all-year round. According to NHS England, attendances at A&E in July were 4.9% up on the same month in 2017. As a result, the proportion of patients seen within four hours in emergency departments fell by one percentage point compared with July 2017. The NHS England figures show 89.3% were seen within four hours, compared with 90.3% in July 2017. But more patients were admitted, transferred or discharged within four hours than in July 2017. At the end of June, almost 88% of patients were on the waiting list for fewer than 18 weeks, missing the 92% target.

Staff numbers tend to rise as providers respond to increased demand and, according to NHS Digital, the NHS workforce increased by 1.6% in the year to March 2018. A total of 1.23 million full-time equivalents were employed in health bodies in England, it said – an increase of 19,800 staff. There had been rises in the number of doctors, midwives and clinical support workers, though nurse and health visitor numbers dropped. Manager numbers also rose by 1,220 compared with March 2017.

Though summer may no longer be the time of reduced demand, it is still a time for national bodies’ annual reports and accounts. In its 2017/18 report, the Department of Health and Social Care confirmed the NHS broadly delivered financial balance. Though providers reported an aggregate deficit of just under £1bn, NHS England achieved an underspend of almost £1bn – even though clinical commissioning groups overspent by a net £200m. The report added that 15% of trusts are disproportionately driving the aggregate variance to plan. Of these, four have overspends of more than £30m.

NHS providers spent more on capital in 2017/18 than the previous year, according to the 2017/18 consolidated provider accounts from NHS Improvement. Providers spent almost £3.4m compared with £3.1m in 2016/17. Trusts held more cash at the end of 2017/18 (£4.9bn compared with £4.2bn at 31 March 2017). Most of the cash is held by foundations trusts.

Meanwhile, in its annual report, NHS England confirmed the commissioning sector ended 2017/18 with a managed underspend of £970m against a budget of £109.5bn. In the report, chief financial officer Paul Baumann (pictured) said £640m of the underspend came from the release of the system risk reserve and other contingencies.

This £640m reserve has offset provider overspends and was made up of the funding set aside by clinical commissioning groups (£360m), £200m set aside by NHS England and a further £80m (from a category M drugs rebate) added in year. With the creation of the £2.45bn provider sustainability fund in 2018/19, NHS England and CCGs will no longer hold risk reserves beyond normal contingencies. CCGs delivered unprecedented efficiencies of 3.1% of their allocations, Mr Baumann added, but overall, they recorded an overspend of £213m. Health Education England (HEE) met its statutory financial duties in 2017/18, underspending on its revenue resource limit by almost £37m (0.76% of total). More than 91% of its expenditure was on training the future workforce, according to its annual report. However, it confirmed investment in workforce development was reduced to help balance the overall budget. HEE said it was planning to avoid further reductions as stakeholders are insisting training is needed to transform the skills of the existing workforce.

A new health secretary for England was announced in July as Jeremy Hunt moved to the Foreign Office in a mini reshuffle following the departure of senior Conservative cabinet members.
Culture secretary Matt Hancock was named health and social care secretary and spoke of his admiration for NHS staff.

He identified workforce, technology and prevention as his early priorities for health and social care and unveiled nearly £500m of funding to support the roll-out of innovative technology.

More than £400m will go towards new technology in hospitals to improve safety and access to health services at home, while a further £75m will help trusts put in place ‘state-of-the-art electronic systems’ that save money, give clinicians more time to spend on patients and reduce medication errors.

There was also change at the Wales Audit Office as Adrian Crompton took over as auditor general for Wales and chief executive of the Wales Audit Office. He has succeeded Huw Vaughan Thomas, who has retired. The role, which carries an eight-year term, is independent of government. Mr Crompton previously held the role of director of Assembly business at the National Assembly for Wales and also worked across the Middle East and North Africa to support the development of political institutions and good governance.  

The Department of Health and Social Care continued to take steps to control costs at a national level, opening a consultation on measures to hold down the cost of branded medicines. It said the proposed changes would ensure the overall growth of branded medicines sales would remain sustainable. The consultation seeks views on how the growth in branded medicines is forecast and changes in the method of calculating a payment percentage – this ensures the Department recovers the difference between the allowed growth, which is set by the government, and forecast levels of sales.

NHS Improvement announced that Brighton and Sussex University Hospitals NHS Trust is no longer in special measures for finance. The oversight body said the trust had improved its financial management and performance since it was placed in financial special measures in October 2016. Financial leadership, control over finances and governance had improved and the trust was on track to meet its financial target for
this financial year. The trust is now developing a long-term financial plan to further reduce its deficit and, while it completes this, will remain subject to formal regulatory oversight.

The Public Accounts Committee has branded NHS England’s outsourcing of primary care support services to Capita Business Services (Capita) as ‘a shambles’. In Supporting primary care services: NHS England’s contract with Capita it said the rush to slash running costs by a third did not take account of the impact it would have on the GPs, dentists, opticians and pharmacists affected. Neither NHS England nor Capita understood the service being outsourced and both misjudged the scale and nature of the risks, ignoring basic rules of contracting, it added.