Technical review - April 2018

The Department of Health and Social Care added an update on the quarter 4 agreement of balances exercise to its web pages in March. While there was a reduction in the value of mismatches between initial submission and resubmission at month nine, the Department said the value of mismatches at resubmission was higher than in previous years. The level of mismatches is above the materiality level and this may be partially due to sustainability and transformation fund balances, the Department said. But it added that improvements made during this financial year must be maintained and continue into the year-end exercise.

A number of new documents on continuing healthcare and NHS-funded nursing care have been published by the Department of Health and Social Care. These include a new national framework, which will be implemented from 1 October, and supporting documents, such as a checklist, a decision support tool and a fast track pathway tool, all for continuing healthcare (CHC). The Department said the revised framework did not change the eligibility criteria for continuing healthcare. However, it clarifies several policy areas. For example, it says most CHC assessments should take place outside of acute hospital settings and clarifies that the main purpose of three- and 12-month reviews is to review the appropriateness of the care package, rather than reassess eligibility. It also introduces new principles for clinical commissioning groups on the local resolution process when individuals request a review of an eligibility decision.  

The HFMA published a briefing on the application of financial reporting standard IFRS 16 on accounting for leases. The HFMA document sets out the basic requirements of the new accounting standard and the decisions that must be made when applying it for the first time. It also reflects on the decisions expected to be mandated by the Treasury and the issues NHS bodies may need to consider. The briefing is an update of one published last November and will be revised as HFMA members discuss the application of the standard and as further government guidance is issued. NHS bodies are being encouraged to start preparing for the changes immediately (see Don’t play the waiting game on leasing changes)

Changes to the Care Quality Commission’s inspection and rating process came into force in March. Acute providers will now additionally be assessed for their use of resources. Following consultation, the care regulator confirmed this assessment will be considered as a sixth key question alongside the existing quality-related questions that aim to assess whether services are safe, effective, caring, responsive to people’s needs and well-led. The new use of resources rating – outstanding, good, requires improvement or inadequate – will be published alongside the ratings for the five key quality questions. The quality ratings will continue to be combined into a single rating on quality, and this will be further combined with the use of resources assessment to give an overall rating.

A new briefing from the HFMA – Understanding the financial position – sets out the importance of reviewing all an organisation’s key financial statements to properly understand financial health. It looks at NHS bodies’ financial targets, including control totals, and looks at the different financial statements and warning signs that governing body members should be alert to. These warnings signs include rising levels of receivables or payables. However governing body members should also understand movements in levels of provisions and maintain a careful eye on cash balances.