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NHS England sometimes has the unenviable job of thinking through all the possible consequences of an unusual situation and making certain the rest of the NHS does the right thing.

The Queen’s death and the coming funeral was one of those situations and it is not surprising to see guidance issued covering what trusts need to do – from informing patients of cancellations to flying flags correctly.

What many trusts might not have expected was being told to identify and potentially charge overseas visitors accessing healthcare – including dignitaries and VIPs. Many of those arriving for the Queen’s funeral next Monday will be from parts of the world without the sort of reciprocal arrangements the NHS still has with European countries and will only be entitled to limited emergency care free of charge.

NHS trusts billing visiting heads of state for their unexpected care is not an image government spin doctors are likely to want to see. As HSJ readers have pointed out, the NHS has recruited many staff from these countries.

And it has a bigger problem to deal with: making sure patients can get the urgent care they need on an unexpected bank holiday.

The surprise surplus

Way back in March 2020, then chancellor Rishi Sunak pledged the NHS would get “whatever it needs” to deal with covid-19. Usual payment rules were suspended and tens of billions poured into the health service.

The health service then ran into an unfamiliar problem. As one finance chief put it: “For the first time in a very long time [during covid]… the NHS had more money than it could spend… What everybody was doing, knowing the dark times were around the corner, was to carry as much forward from one year to the next.”

As a result trusts are now sitting on around £18bn of cash reserves – three times higher than in March 2020 – and are now using this cash pile to plug holes in day-to-day spending in today’s much harsher financial envelope.

Any help will only be short-term, however, as the surplus is non-recurrent and can only be used once. Nuffield Trust senior analyst Sally Gainsbury said: “It’s basically like a household having to dig into life savings to pay for food… sooner or later the savings run out and they are left with an annual income that does not cover annual costs”.

Also on hsj.co.uk today

In our comment section, Anna Charles says integrated care systems can help foster collaboration between partners to offer new solutions to entrenched problems but face risks in how they respond to national asks. And in our weekly look at health coverage across the media, The Primer reports on how NHS leaders have been paying tribute to the Queen.