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

No deal?

Simon Stevens told the Commons health and social care committee on Tuesday he intends to enact no-deal Brexit plans before Christmas, if no deal is agreed domestically by that point.

He said: “Frankly, this side of Christmas, were we to be in a no-deal scenario, some of those [NHS England] plans will have to be enacted.” 

The NHS England chief executive added these would include “decisions… which would mitigate some of the supply chains issue already discussed” plus issuing “practical instructions…[to] GPs, NHS hospitals and others”.

Prime minister Theresa May has announced Parliament will vote on her current withdrawal bill on 11 December. This means if the deal is rejected or further amendments called for, NHS England would likely start working towards a no-deal scenario.

Mr Stevens also confirmed trusts have been asked to submit the outcome of supply lines and contract reviews to NHS England by the end of this month. He said NHS England and the Department of Health and Social Care will make a “comprehensive assessment in [the] first 10 days of December about what that is telling us” and further action on the supply chain could be taken at that point.

Meanwhile, health and social care secretary Matt Hancock confirmed that drug supply plans are being considered if six weeks of medicine stockpiles were not enough. He told the committee there is “only so much stockpiling one can do” and a range of other options are being discussed including “prioritisation” of drugs.

It is not clear what he means by this. It could be prioritising drugs at the border over other products or it could be rationing the volume of drugs prescribed per patient, as NHS England recently had to do during an EpiPen shortage.

Mr Hancock also refused to “guarantee” that no one would die as a result of a no-deal Brexit, after it was rumoured he’d raised that as a concern during a heated cabinet debate on the withdrawal agreement. He told the committee “We shouldn’t use words such as guarantee but what we can say is that if everybody does what they need to do then there will be continuity [of drug supply]”. We’re not convinced that will assuage patients’ concerns.

No long term plan?

In the same committee session Mr Hancock disclosed that the NHS long term plan is no longer likely to be published next week, when many in Whitehall had it pencilled in for. He said he still wanted the plan – and the long awaited social care green paper – to be published before the end of the calendar year, but didn’t sound 100 per cent certain even this would be achieved. 

NHS England, you would think, would be keen to get the plan out next week and out of the way, giving the NHS a sense of direction before the 11 December Brexit vote potentially wreaks more havoc. But the timing is not all in NHSE’s gift – Mr Hancock wants to help shape the plan, and others across government will have strong views too.

Of course the “meaningful vote”, if lost badly, could bring down the prime minister altogether, meaning a long term plan responding to her funding envelope and priorities may be a little redundant anyway. 

Does anyone have a Plan B? And will nobody think of the tight NHS planning schedule amid these historic events?

A final PS from the select committee: Mr Hancock said the “assumption” in Whitehall was that health education and training budgets beyond next year would, under the spending review, receive “flat real” funding. Real terms cuts would be stopped, but with no correction. 

As short as possible. But no shorter

Cutting patients’ length of stay to free up beds represents a core plank of NHS England’s winter capacity planning. And rightly so. Good patient flow represents the best outcome clinically as well as for efficiency and patient experience.

But optimal efficiency must not tip into overzealousness, with patients being discharged too soon, one of the country’s most senior geriatricians has warned.

The British Geriatrics Society’s new president Tahir Masud told HSJ trusts must closely watch emergency readmission and mortality rates at the same time as trying to cut length of stay to ensure patients are not being discharged prematurely.

A timely warning. A Healthwatch England study has also just revealed emergency readmissions within 30 days of discharge have rocketed – up nine per cent over the last 12 months alone, across a group of 70 trusts which it had obtained data for.

The reasons driving the high readmittance rates are unclear, but it is well worth trust leaders being wary of the risks, as well as the rewards, of driving down length of stay.