News / News review – March 2022

Tough winters are par for the course in the NHS, and another regular feature of the healthcare year emerged – claim and counter-claim on pay awards. In evidence to the NHS pay review body, the Department of Health and Social Care called for Agenda for Change pay rises of no more than 3% in 2022/23 – a proposal that would ‘go down like a lead balloon’, according to Unison head of health Sara Gorton. The Department insisted the NHS budget was now set, and for it to remain balanced there had to be a trade-off between pay rises, tackling waiting lists and increasing staff numbers. It also called for pay restraint for doctors, dentists and senior managers, insisting hospital consultants should get no more than 2%. Multi-year deals are in place for other medical staff.

The Royal College of Nursing (RCN) warned of nurse shortages. Workforce shortfalls were affecting trusts’ ability to provide safe and effective care before the pandemic – and the situation is now worse, it added. Immediate action to increase nursing supply is needed. The RCN said that, going into the pandemic, 73% of nurses surveyed believed staffing on their last shift was insufficient to meet patient needs. Patient care was compromised, according to 57%. The union added that one in five nurses are aged 56 or more, and will be due to retire in the next few years.

Councils are increasingly concerned that the costs of the government’s adult social care reforms will exceed funding, according to the Local Government Association. The LGA said cost pressures will include the ‘fair rate for care’ that councils will pay providers. Without adequate funding some councils will struggle to balance their budgets, worsening existing pressures and risking the delivery of timely, quality care, the LGA said. In February, the Department confirmed an additional £1bn for 2022/23, including increases in core social care funding via £636m in social care grant. Public health funding will increase by 2.8% in cash terms, and the public health grant will be more than £3.4bn in 2022/23.

The power-sharing executive in Northern Ireland collapsed in February, so local health and personal social services will not receive the planned rise in funding from April, unless the executive is restored. The draft Budget had proposed a 10% real-terms uplift for health over three years, but this cannot happen without a first minister and deputy. Current year budgets will continue into 2022/23. Under devolution arrangements, other ministers can remain in place, but with limited powers. Finance minister Conor Murphy said his legal advice was that budgetary measures cannot be implemented without an executive. He added that the proposed shift to three-year planning could also not now be introduced.

An overview of NHS Scotland finances in 2020/21 said the Covid response significantly affected health boards’ ability to make efficiency savings. Audit Scotland said several boards relied on government support and £102m was allocated to 14 NHS boards to achieve financial balance – this shortfall was recurring. Six boards with particularly challenging financial positions are receiving additional support. The report added that the Scottish government must transform health and social care if it is to address the growing cost of the NHS and Covid recovery. The NHS was not financially sustainable before the pandemic, and Covid had increased those pressures.

The 2020/21 financial position of the NHS in England was outlined in the Department’s annual reports. It said NHS commissioner and provider sectors ended the financial year with an underspend. This was due to the uncertainty around the Covid pandemic and a reduction in non-Covid activity as providers focused on their response to the virus. The annual report and accounts for 2020/21 noted a £3.5bn underspend in non-Covid budgets. Measures taken to support providers, including the temporary financial regime and write-off of historical deficits, had ensured the sector had a ‘healthy’ net surplus of £655m, the Department said. However, auditor general Gareth Davies qualified the financial statements for several reasons, including lack of evidence over the accruals balance (see Financial reporting: not many changes but another difficult year).

The government is to consult on capping legal costs in some clinical negligence cases in a move that it said could save the NHS £500m over 10 years. The proposal applies to lower value clinical negligence claims – typically between £1,001 and £25,000. Legal fees in these cases have been ‘increasing and disproportionate’, it said, while the National Audit Office has identified claimants’ legal fees as a significant factor in the rising overall cost of clinical negligence. The consultation closes on 24 April.

Health secretary Sajid Javid set out his digital ambitions for the NHS, saying electronic patient records (EPRs) should be used in 90% of trusts by December 2023. Mr Javid said progress on EPRs had been ‘undeniably brilliant’ but inconsistent, with 20% of trusts having no EPR. There should also be a focus on social care, he said, but around 40% of providers had yet to adopt a digital social care record. Mr Javid hoped three-quarters of adults in England would be using the NHS app by March 2024.

Early payment schemes, promoted by former government adviser Lex Greensill’s company, had no clear rationale, the Commons Public Accounts Committee said. The PAC looked at schemes with Greensill Capital, which included a pharmacy early payment scheme arranged with the Department of Health and Social Care, and a salary payment scheme with trusts. Mr Greensill told the government the former would save £100m a year, but the Department cannot provide evidence of benefits realised, the PAC said. Only 14% of pharmacies took up the scheme, compared with the anticipated 60%-80%. When Greensill Capital collapsed in 2021, no finance provider was willing to take on the scheme, and the government had to step in. The early salary scheme was marketed to trusts from 2019, but the PAC said government advice that trusts should avoid these sorts of schemes was not communicated until recently. A number of trusts took up the scheme, but they were now picking up the costs, the PAC added.

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From the HFMA