The must-read stories and debate in health policy and leadership.

The age-old problem of provider deficits

Although they are now overshadowed by staggeringly poor accident and emergency performance figures, NHS provider deficits are a problem that won’t go away.

The official mid-year performance figures for the sector showed little improvement to previous years, and analysis by HSJ suggests they will continue to get worse.

Several of the country’s largest trusts have been reviewing their forecasts during the third quarter of the year, including: University Hospital Southampton Foundation Trust; Barts Health Trust; and London North West University Healthcare Trust.

Oxford University Hospitals FT has already admitted it will miss its underlying control total by £17m.

This is a familiar story, but it was all supposed to be different under the new funding settlement that kicked in this year. Deficits were never going to be eradicated in the first few years, but the government will expect there to be significant improvement.

Coroners’ powers to issue prevention of future death reports often result in embarrassing publicity for trusts and other organisations on the receiving end of them — but do they result in meaningful change for patients?

Veronica Hamilton-Deeley, the senior coroner for Brighton and Hove, might say “not often enough” after issuing a third report focussing on patient transfers at Brighton and Sussex University Hospitals Trust.

In the most recent case, 88-year-old Jean Waghorn was moved three times in just over 48 hours. The first time was to make sure the patient could access specialist care at the Royal Sussex County Hospital, but then she was moved twice more for reasons Ms Hamilton-Deeley viewed as “not appropriate”, although she adds she cannot say the transfers contributed to her death.

Ms Hamilton-Deeley had been assured after her two earlier reports that a trust-wide transfer policy working group had been set up and new assessment tool sheets were created — but none of these were used in the most recent case. Not surprisingly, Ms Hamilton-Deeley is now asking what the point is of prevention of future death reports if trusts ignore them.

The trust says it is working to make sure the changes made following the earlier reports are “consistently applied”, but the case raises wider questions about the effectiveness of such reports.