1/14 NHS financial allocations for second half of the year released overnight. Thread of initial thoughts below. Probably of most interest to those steeped in, and fans of, the delights of NHS finances. But some potentially big issues depending on how this plays out.....
2/14 NHS frontline been waiting for allocations for some time, so good that they have finally arrived. There is a lot of complexity here. These allocations have been made at system level for the first time and they also include some detailed calculations on individual items.
3/14 Four specific areas of concern that we expect trusts to raise. First, some ambitious assumptions about recovering non-NHS income that will be a significant issue for a number of trusts who are a long way off from seeing their non NHS income return to pre-COVID levels.
4/14 Second, COVID-19 may hit differentially in a possible second wave, and if trusts experience significantly higher costs than expected, these may not be covered. We need details on how any emergency finance process, in event of localised second surges, will work if needed.
5/14 Third, non covid costs for 2H calculated by rolling over 1H costs and stripping out non recurrent items like Nightingale set up costs. Vital only non recurrent costs have been stripped out and that the covid related cost element of these allocations is appropriate.
6/14 Fourth, trusts will want more detail on exactly how the claw back of allocations will work if ambitious service recovery targets are not met and what flexibility there will be if those targets are not met for good reason. There is.....
7/14 There is very good progress on restoring services and activity volumes - trusts are going faster than they expected a few months ago. But we still think majority won't meet targets. Though that definitely won't be for want of trying!
8/14 Trusts telling us this morning that it will take them time to work out detail of what this means for them. Complex work needed to bring together income streams from within their system allocation, from other system allocations and from direct/specialised commissioners....
9/14 They also need to understand adjustments which have been made for costs which will be funded nationally in the second half of the year. There are some big shifts here - for example PPE costs and cost of some independent sector contracts now being borne locally
10/14 Initial, first off, reactions generally ones of concern that allocations look lower than expected & insufficient to cover expected costs. We understand NHS did not get all it asked for from Treasury and this will, by definition, affect size of frontline allocations.
11/14 NHS England and Improvement tell us that what initially might look like a large financial gap will close once trusts have accounted for all their full sources of income and the costs that will now be covered nationally. But we obviously need to be sure this occurs.
12/14 If financial gaps don't close, we risk trusts dialling back on what they're currently spending on service recovery / preparing for winter. This is the last thing we want. Vital that strategic intent and funding flows match each other. Patient care at risk if they don't.
13/14 NHS England and NHS Improvement have assured us that they will carefully consider any request from a system or trust that genuinely believes it has an insurmountable problem. This will need to be followed through if required.
14/14 Summary initial reactions. Lot of complexity. Significant concern allocations look inadequate. Hope, when detail worked through, large looking financial gaps won’t end up as big as they currently seem. Lot riding on detailed work over the next few days!

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More from @ChrisCEOHopson

15 Sep
1/14 Widespread media pick up this morning of our press comment on trust leaders' concerns that current test shortages are impacting negatively on NHS staff and patients. Press comment can be found here: nhsproviders.org/news-blogs/new…. Thread follows.
3/14 Trusts are concerned that current test shortages mean NHS staff are having to self isolate because they, and their family members, who need a test, can't access one. Worries this will affect vital service delivery, service recovery and winter preparations.
Read 14 tweets
16 Aug
1/11 @NHSProviders response to reports on future of PHE. Quick thread summarising the argument below - we all need to learn lessons from covid-19 in a spirit of learning, not blame apportionment. Government included. Much that we can do better, together, in public health. ImageImage
2/11 Five obvious issues on public health that NHS trust leaders think COVID-19 has highlighted. We look forward to seeing whether the Government's plans for the future of @PHE_uk reflect these lessons.
3/11 Lesson 1: Years of underfunding for Public Health England, and public health more widely, resulted in UK not being properly prepared to tackle pandemic like COVID-19. E.G. local authority public health grant has been cut by 25% in real terms over the last five years.
Read 12 tweets
12 Aug
1/12 Trust leaders frustrated and disappointed to see the service they have been providing over the last few months described, and widely reported, last week as "covid only". It's untrue, unfair and potentially dangerous. My new blog here: nhsproviders.org/news-blogs/blo…. Thread follows.
2/12 Even at the height of coronavirus, for every one COVID-19 patient in hospital, there were two non-COVID inpatients being treated for other conditions. More than three million urgent tests and checks were provided over the pandemic and 3.6 million people were treated in A&E.
3/12 NHS has continued to deliver, on average, 1,800 babies a day every day since the pandemic started. Although cancer referrals did drop, 65,000 patients started treatment for cancer during the pandemic. Yes, 14% fewer than same three months last year. But hardly covid-only.
Read 12 tweets
30 Jun
1/17 Today, we're launching results of first major survey of NHS trust leaders since covid-19 started. The report - "Recovery Position, What Next for the NHS" looks at challenges facing NHS to treat covid 19 patients and restart services. Report here: nhsproviders.org/media/689775/r…
2/17 You can find the press release (good summary) of our new report on the challenges facing the NHS as it restarts services here: nhsproviders.org/news-blogs/new…. Linked blog can be found here: nhsproviders.org/news-blogs/blo….
3/17 Four key messages from first member survey post covid-19: lot more patients now needing treatment; trusts losing lot of capacity due to covid-19 (up to 40%); trusts going as fast as they can to restart services; but it will take some time to resume full range of services.
Read 18 tweets
14 Jun
1/23 This week has seen the first data release from NHS Test and Trace so a good point to assess its progress so far and look at what now needs to be done. Thread follows. Usual basis, we're not Government or @NHSEngland, we're the voice of NHS trusts: nhsproviders.org/news-blogs/pre…
2/23 Rapid, good, progress has been made since early May to establish a working, national level, phone and online based, contact tracing service, linked to the national testing regime. This is a significant achievement, given the context, and deserves appropriate recognition.
3/23 However it’s clear that, as a nation, we are coming to this very late - much later than other countries. We would be in a much better position had this work been started, with this team, in March not early May. Public inquiry will need to identify why this didn’t happen.
Read 23 tweets
12 Jun
1/16 There's been a lot of coverage of, and twitter traffic on, recent, helpful, @NAOorguk and @1adass reports today, significant amounts of it focusing on NHS discharges to care homes. I thought it would be good to post another twitter thread on this, drawing on the new reports.
2/16 Usual basis – we are not Government, we are not @NHSEngland, we are the voice of trusts. Full basis of comment here: nhsproviders.org/news-blogs/pre…. We recognise there is a different perspective from the social care sector. We are communicating what trusts have told us.
3/16 We strongly agree with the key @NAOorguk report sentence (Summary point 16) “Due to government policy at the time, not all patients were tested for COVID-19 before discharge, with priority given to patients with respiratory illness or flu-like symptoms”.
Read 16 tweets

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