News / News review - Seamus Ward assesses the past month in healthcare finance

September was a month of new faces at the top of healthcare in England and Scotland following reshuffles by David Cameron and Alex Salmond. South of the border, former culture secretary Jeremy Hunt replaced Andrew Lansley. In Scotland Alex Neil became cabinet secretary for health and wellbeing, replacing Nicola Sturgeon, who has taken over infrastructure, investment and cities.

Mr Lansley, health secretary since the formation of the coalition government in 2010 and shadow health secretary from 2004 to 2010, is now leader of the House of Commons. He moves on having piloted a major shake-up of the health service in England through Parliament. The changes will kick in from next April. Mr Hunt’s appointment is seen by Westminster watchers not as signalling a change in policy but as Number 10 putting its man in charge to lead the delivery of £20bn savings by 2015, a move to a new system, and to prepare for the next spending review.

A reshuffle in Mr Hunt’s junior team moved on all but Lord Howe, who remains health minister in the Lords. New are Lib Dem Norman Lamb, who will oversee finance, and junior ministers Daniel Poulter and Anna Soubry. While Mr Hunt has a reputation for being error-prone, Ms Soubry sparked storms from Tory backbenchers when she labelled the law on assisted suicide ‘ridiculous’ and admitted the government had ‘screwed up’ in failing to adequately explain its reforms.

The new health team has not led to a pause in the reforms in England. The Department announced specialised services would become the responsibility of the NHS Commissioning Board (NCB) from April 2013. The services account for £11bn a year – about 10% of the NHS budget. The NCB said national commissioning would ensure clinical commissioning groups do not have to fund unpredictable and occasionally expensive treatments, while nationally consistent service specifications would be developed.

The NCB said four ‘scale’ communications and engagement collaboratives would be established. Each will be led by a commissioning support unit (CSU) and all CSUs planning to provide communications services, locally or at scale, will have their proposals tested at the next assessment (checkpoint 3). CSUs should show their involvement in a communications collaborative whether they buy at-scale services or not.

There will be a slight delay in the authorisation of the first wave of clinical commissioning groups (CCGs) to allow CCGs to comment on the authorisation conditions the NCB intends to place on them. The NCB said this would add four to five weeks to the authorisation process in each of the four waves.

The inquiry into the care failings at Mid Staffordshire NHS FT will not now be delivered this month. Inquiry chair Robert Francis said it had gathered a huge amount of information and he needed time to complete all the formal processes needed to ensure the report was fair. In the meantime, Monitor has gathered experts to recommend a viable, long-term solution for the services provided by Mid Staffordshire NHS FT. Solutions to be considered include a ‘solvent restructuring’ of the trust and placing the trust in special administration. A final report is due next spring.

The Department of Health insisted there was no evidence strategic health authorities planned to ‘raid’ education budgets in 2012/13. In its response to the Commons health committee report on education, training and workforce planning, it said each SHA had an agreed investment plan setting out how they would meet the service level agreement they had made with the Department. Work to develop tariffs for postgraduate medical placements and primary care placements will continue in 2012/13 and be implemented ‘as soon as possible’. It also confirmed the first tariffs for non-medical education and training will be implemented from April 2013.

Last month’s report by a consortium of NHS employers based in south-west England, which claimed 6,000 jobs could be saved by reforming national terms and conditions (Healthcare Finance, September 2012, page 4) was rebutted by the Royal College of Nursing. The college said a move away from national contracts would threaten the delivery of healthcare to vulnerable patients. Responding to the South West Pay, Terms and Conditions Consortium, the nurses’ union said trusts had to stop looking to regional pay as a panacea for their financial position. It is writing to the 20 trusts in the consortium setting out the RCN concerns.

But 25 economists have urged the government to abandon national pay bargaining in the pubic sector, claiming it’s ‘bad for Britain’. In a letter to The Times they said the public sector wage bill for each region should be the same and individuals able to negotiate their own pay. Savings could be used on frontline services. Chancellor George Osborne (left) has asked the NHS and senior salaries pay review bodies to look at implementing regional pay in the health service and other parts of the public sector.

Acute hospitals could be on the brink of collapse, according to a report from the Royal College of Physicians. Hospitals on the edge? The time for action said services must be reorganised and some hospitals may need to close to improve care. The doctors’ body said acute units were struggling to keep pace with demand. It added there are a third fewer general and acute beds than 25 years ago, but in the past 10 years emergency admissions had increased by 37%. It called for the redesign of services to better meet patient needs and the reorganisation of hospital care so patients can access expert services seven days a week.

NHS organisations can rest easy, according to the NHS Confederation. They have avoided an aggregate annual bill of £70m a year thanks to a European Parliament decision to amend proposals that would have required public bodies to renovate 3% of their buildings’ floor space each year to increase energy efficiency. Following the vote the rules will not be mandatory, although NHS organisations will still be encouraged to make energy efficiencies.