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

Ambulance services are caught between a rock and a hard place at the moment. The need to satisfy the Care Quality Commission that they are not putting patients at risk can collide with the need to stay within budget and to maintain relationships with trusts and integrated care systems when accident and emergency handover delays explain much of the poor response times.

This is now playing out in the West Midlands where the CQC served West Midlands Ambulance Service University Foundation Trust with an improvement notice focusing on its category 2 response times.

WMAS calculates it loses 250,000 hours a year from ambulances sitting outside hospitals. To improve performance, either this has to be resolved – which there is little sign of – or it will need to take on extra staff and buy more ambulances at a cost of £20m. If the latter, and the money is not forthcoming, it should set a deficit budget reflecting this, a paper to the board recommends.

If that sounds a high stakes game, it is probably a reflection of the frustration within WMAS that no solution to these issues has been found, despite it repeatedly raising the issues both in public and behind closed doors.

Present and correct

Six integrated care systems are telling hybrid working staff they must work from the office either one or two days per week.

HSJ has found the Derby and Derbyshire, Northamptonshire, Kent and Medway and Surrey Heartlands ICSs tell hybrid staff they are expected in the office at least two days per week in most cases. At Lincolnshire and Frimley ICSs, there is an expectation of one day office working per week.

It comes as NHS England is set to impose a new policy next month requiring staff to work at least two days in the office a week from April, after almost four years of many staff being able to work from home full time.

A further 31 systems said they either had no set “days in office” policy for hybrid workers, or that they left this up to individual teams. The remaining five systems did not provide details by time of publication.

NHSE said: “In-person working has many recognised benefits and is particularly important for staff at the beginning of their career or starting new roles.”

Also on hsj.co.uk today

NHSE’s efforts to chivvy ICSs into line on their financial plans appear to be coming up short, writes Henry Anderson in Following The Money. And in Comment, Adam Sampson says Blair and Brown missed the opportunity to think big despite winning a mandate for change and hopes that history doesn’t repeat itself.