MIAA is a member of the Internal Audit Network (TIAN) which comprises the seven NHS internal audit consortiums and in house teams operating in England. These organisations collaborate across a number of areas to leverage their collective knowledge and expertise and drive efficiency and effectiveness. The monthly insight report highlights key publications and is intended as a useful update and reference tool. This report is produced by TIAN and shared by MIAA. 

HM Government - Get Britain Working White Paper

The government has published a “Get Britain Working” White Paper, backed by £240 million of investment, designed to drive forward approaches to tackling economic inactivity, and work towards the long-term ambition of an 80% employment rate. 

The investment includes funding to tackle ill health as the biggest driver of inactivity. As part of this, the government is investing in eight areas across England and Wales, to integrate and improve local work, health and skills support. This will include funding in three of the trailblazer areas for integrated care system accelerators to improve population health outcomes and reduce health-related economic inactivity.  The NHS Confederation has published a summary briefing.

For information

Department of Health and Social Care - Chief Medical Officer's annual report 2024: health in cities

This report finds that people in cities often use the NHS and health care differently than those in other areas, given the transient nature of some groups within city populations. Health challenges in cities addressed in the report include: the health effects of housing; the food environment; lower vaccination and screening rates; high rates of sexually transmitted infections; access to exercise and physical activity; and air pollution.

For information

Department of Health and Social Care - Right Care, Right Person

The Right Care, Right Person (RCRP) approach aims to ensure that people of all ages who have health and/or social care needs are responded to by the right person, with the right skills, training and experience to best meet their needs. This analysis, carried out in partnership with the Home Office, evaluates the implementation of the RCRP approach from a sample of police, fire, health and social care services in England.

For information

NHS England - Assessing and managing risks across ICSs

The National Quality Board provides a range of guidance for assessing risks in complex health care scenarios. This document compliments the NQB’s guidance and outlines principles for managing quality risks within integrated care systems, particularly in rapidly changing environments, and dealing with multiple factors. It aims to support the delivery of safe, effective and personalised care while addressing inequalities across health services. It covers the purpose and principles, definitions and approaches to assessment and assessing risks in practice. It is supported by a series of case studies.

For information

NHS England - Violence prevention and reduction standard

Organisations should use NHSE’s updated Violence prevention and reduction standard to assess themselves across the 7 domains to take action to prevent and reduce violence and abuse against staff.  It now includes a new Red, Amber, Green (RAG) rating that helps organisations identify areas to action and measures progress over time.

For information

NHS England - Enabling staff movement across organisations 

NHSE has updated its toolkit for sharing staff safely and efficiently includes recommendations and guidance and contains content on: defining the different types of staff movements, the NHS digital staff passport, and example text and agreements to help you to set up workforce sharing arrangements.

For information

NHS England - Operating Pressure Escalation Level (OPEL) framework

NHSE’s 2024 to 2026 OPEL framework for the management of operational pressures sets out the core parameters that providers must use to determine their OPEL. The framework provides a unified, systematic and structured approach for a co-ordinated response to operational pressures at system, regional and national levels. It has been expanded to the contribution of community, mental health and NHS 111 services to ICS pressures and is supported by appendices that detail additional information by provider type.

For information and implementation by NHS Providers

Care Quality Commission - Maternity survey 2024

This survey looked at the experiences of pregnant women and new mothers who used NHS maternity services in 2024. It shows some areas of improvement over the past year, particularly regarding access to mental health support during pregnancy. However, there remain other aspects of maternity care where people report a poorer experience and where analysis indicates a longer-term decline in positive feedback over time. These include communication during labour and birth, information provided during care in hospital after birth, and involvement in postnatal care.

For information of maternity service providers/commissioners

General Medical Council - The state of medical education and practice in the UK: workforce report 2024

This report highlights the changing nature of the country’s medical workforce. It finds that, UK-wide, the overall headcount of doctors rose in the past year at the fastest rate since the report began over a decade ago. But one group has been growing much faster than others – locally employed (LE) doctors. LE doctors are employed on local terms by trusts and health boards, rather than employed in formal postgraduate training programmes. The report argues that the roles are often poorly defined, with limited opportunities for career progression and training, and many LE doctors employed in short-term or non-permanent posts.

For information

Royal College of Physicians - Bridging the gap: a guide to making health inequalities a strategic priority for NHS leaders

This guidance aims to build physician understanding of health inequalities and the actions that medical staff can take to make this a bigger priority in their workplace. It explains the importance of addressing health inequalities in the NHS and sets out the existing statutory duties and guidance given to NHS organisations on health inequalities. It also identifies the barriers and enablers to systems in prioritising work on health inequalities.

For information

British Red Cross - Seen and heard: understanding frequent attendance at A&E. An analysis of linked data in Dorset

This report finds that people who frequently attended A&E in Dorset were 72% more likely to live in an area of deprivation. Other common issues included mental ill health and multiple long-term health conditions. Many of those frequently attending A&E had often tried to get other help, but this had not met their needs. This meant that when they reached A&E, they were often in need of more urgent care.

For information

Age UK - You are not alone in feeling lonely: loneliness in later life

This report presents new evidence about the scale of the loneliness challenge among people aged 65 and over, revealing that 270,000 older people in England go a week without speaking to a friend or family member. It also explores why loneliness is harmful to older people’s health, wellbeing and quality of life.

For information

Bright Blue - Empowering ICBs: a blueprint for fixing the NHS

This report offers policy recommendations to strengthen integrated care boards (ICBs) in four areas: the funding of ICBs; performance measurement of ICBs; governance and involvement of ICBs; and supporting ICBs that are ‘lighthouses’.  The report examines ways in which further devolution of powers and resources to Integrated Care Boards (ICBs) while holding them to account through patient-focused performance outcomes will help improve performance and efficiency in the NHS.

For information of ICBs

Financial Reporting Council (FRC)  - NHS audit market study: emerging findings

The FRC has published the emerging findings from its NHS audit market study, which it launched in July. It concluded that the NHS audit market is functioning, but that there are issues that may risk future resilience. These issues may be limiting the choice of auditor for some NHS bodies, especially in certain parts of England – with 87% of NHS bodies responding to the council’s survey concerned about their choice of auditor for the next audit. Issues identified include constraints on market capacity, created by timetable pressures, conflicts of interest and geographic limitations. There are also concerns about procurement frameworks and different views on the value of NHS audits. The FRC, whose research was informed by an HFMA survey and two roundtable discussions with NHS finance professionals organised by the association, is consulting on its findings. with comments sought by 6 February 2025.

For information and engagement/comments by individuals and organisations

HFMA - Charity regulators: update for NHS charities

This briefing gives an update on recent guidance from the three charity regulators and other relevant bodies that is likely to have an impact on the financial management and governance of NHS charities. It is based on the information that is available from their websites and provides appropriate links to that guidance.  The briefing covers recent updates in relation to the Charities SORP and the various codes of governance for charities.  It also covers recent updates in relation to changes to legislation and guidance from the:

• Charity Commission for England and Wales
• Office of the Scottish Charity Regulator (OSCR)
• Charity Commission for Northern Ireland
• Fundraising Regulator and Scottish Fundraising Adjudication Panel.

For information of NHS Charities 

HFMA Briefing - Non-standard value for money audit reports

Since 2020/21 auditors have included a commentary on value for money (VFM) in their auditor’s annual report (AAR). With the change in reporting, auditors now provide judgement and recommendations on three criteria - financial sustainability, governance and improving economy, efficiency and effectiveness.  Where there are significant weaknesses, the auditor makes recommendations to the audited body, and these are set out in the auditor’s annual report. This briefing gives an assessment of the significant weaknesses identified by auditors from their VFM work and their recommendations to address these concerns.  

To identify any potential lessons arising from these reports, the HFMA examined the non-standard VFM reports with qualifications in 2020-2023, to see if there were any common issues that could be pulled out for other NHS organisations.  They then undertook further analysis to see if any additional lessons could be learned from the providers that addressed their concerns in 2021/22, the providers that only had qualifications in 2022/23, and the newly formed ICBs.  The analysis identified two dominant areas of concern: 

• not meeting Care Quality Commission (CQC) standards – reflecting service quality issues
• unidentified cost improvement programmes (CIPS) – particularly incidences where funding gaps are present in plans but the specifics on how they will be addressed are not yet known.

For those not meeting CQC standards, the ‘well-led ‘domain was most consistently highlighted as an issue in the reports but other major difficulties such as with maternity and emergency care were also noted. The concerns highlighted by auditors were predominately regarding the governance arrangements in place such as failing to implement timely improvements, lack of embedded action plans, and weaknesses in monitoring. Auditors provided recommendations such as developing action plans and embedding them trust-wide, tracking and reporting progress on action plans at board level, introducing rigorous performance measurement and monitoring procedures and strengthening risk management processes. 

Auditors also made a number of specific recommendations in developing CIP programmes/plans. Aside from the findings from the auditors’ reports, undertaking this research has highlighted the fact that not all NHS bodies meet their statutory duties to publish their annual report and accounts and AAR on their website.

More here

For information

HFMA – 2024 Award Winners Showcase 

Award winners were announced during the HFMA annual conference in December 2024.  The HFMA Awards 2024 supplement showcases this year’s winners, and those shortlisted for awards. There are 13 award categories, and the supplement also covers One NHS Finance awards and the presentation of Towards Excellence accreditation certificates.  This year’s winners included TIAN member 360 Assurance in the Governance category, with other award categories including:

• Finance Director of the Year
• Finance Team of the Year
• Working with Finance – Clinician of the Year
• Delivering Value with Digital Technology
• Diversity and Inclusion
• Environmental Sustainability; and
• Addressing Health Inequalities through NHS Finance Action

For information

Social Market Foundation - In the blink of an AI: clearing the backlog in UK public services

This report outlines the benefits the civil service and public sector can reap by further integrating AI and automation into their user-facing workstreams, as well as the time savings available to the public that use them. It looks across different types of public sector organisations, where AI was being adopted in public-facing services such as DVLA, GPs and HMRC. The report argues that AI could cut patient waiting times by almost three-quarters (73%) overall and almost half (47%) during peak times, ending the notorious ‘8am rush’ for appointments.

For information

AI in NHS Communications Taskforce - An engagement paper on the effective use of artificial intelligence in NHS communications

A taskforce was established in early 2024 to explore the potential use of AI in NHS communications and to guide communications professionals in how to take advantage of the opportunities offered by AI, while mitigating the risks. This engagement paper, published in partnership with the NHS Confederation, outlines proposals for implementing AI tools across all NHS communications channels. The document synthesises the insights gathered so far and poses targeted questions to NHS communications professionals. This engagement period will end on 28 February 2025.  In the spring of 2025, a final operating framework will be published.

For information and engagement by individuals and organisations

Disclaimer: This briefing paper is intended to highlight recent developments and issues within the NHS that may be of interest to non-executive directors, lay members and NHS managers. It is not exhaustive and TIAN cannot be held responsible for any omission.