Last year HSJ questioned NHS Eng finance boss Julian Kelly about the pressure being placed on local leaders to agree unrealistic financial plans.

He seemed irked & confidently said more ICSs would 'definitely' hit their plans in 2023-24 than the prev yr.

So what happened?
1/🧵 @HMAnderson39 has calculated that 25 missed their plans in 2023-24 - which is more than half.

And that was significantly up on the 18 integrated care systems that missed in 2022-23.



2/hsj.co.uk/finance-and-ef…

Good to see The Christie whistleblowing saga getting some mainstream attention now from the MEN & BBC (Newsnight featuring it this evening)

manchestereveningnews.co.uk/news/greater-m…

HSJ has been highlighting the problems for almost 3 years....

🧵1/ In October 2020, we first revealed NHS England had launched an investigation into 'bullying' concerns from whistleblowers

2/

hsj.co.uk/the-christie-n…

Leadership of famous cancer trust The Christie has been downgraded by two ratings - from outstanding to 'requires improvement'.

This was despite personal praise for the medical director, chief nurse, and COO....

🧵1/

hsj.co.uk/the-christie-n… This comes after the CQC received multiple concerns from whistleblowers about the leadership culture- and two independent reviews which identified numerous failings around a major research project.

2/

hsj.co.uk/the-christie-n…

The ambulance handover crisis hit a new low in Oct, with reports of nasty 'standoff' situations between paramedics & staff at Aintree A&E in Liverpool

But the problem now seems to have spread to the city’s other acute site, the newly opened Royal Liverpool Hospital...

🧵1/8 I've been told about similar clashes between Royal staff & ambulance crews last week, around the number of patients being brought into the ED. In some cases, sources said arguments have broken out in front of patients.

2/8

Lots of work ongoing across NHS to analyse disparities in health & care of patients from different economic/racial backgrounds

Evidence clear– those from >affluent areas more likely to be healthier & to receive quicker care. Same goes if you're white

What to do about it?

🧵1/7 Wide consensus within NHS that it should be doing something – NHS constitution says it has a “wider social duty to promote equality… & to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace”.

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Revealed:

NHS balance sheets are in a far stronger position than pre-covid, with cash levels 3x what they were in 2019.

Much of the ££ that poured into the NHS during covid couldn't be spent -but finance teams were able to 'mask' that surplus

Thread🧵

hsj.co.uk/finance-and-ef… It means trusts can draw on those cash reserves in 2022-23 to help meeting financial targets that look impossible on paper...

To do this they'll need to use 'aggressive' accounting measures which reduce recorded 'expenses', compared to the amount of cash being spent.

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