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

The most concerning GIRFT report yet

The latest Getting It Right First Time report is probably the most concerning so far.

The £60m national clinical outcome and efficiency programme’s latest publication is on cranial neurosurgery, a highly complex set of procedures carried out at 24 centres in England.

The report found bed shortages were hitting this specialism particularly badly, with significant delays in elective, and sometimes, urgent treatment.

The problems touch lots of different policy areas; a lack of step-down beds; increases to surgery cancellations, poor transfer agreements; and a lack of community facilities to take some of the pressure off outpatients.

A series of coroners court cases have shown the terrible consequences when the system works under too much pressure.

NHS Improvement is asking the providers to make the recommended changes by June 2019.

A risky game 

The death of a 91-year-old stroke victim who waited nearly 19 hours for an ambulance was among seven unpublished serious incident reports involving long ambulance delays in the East of England, obtained by HSJ.

The reports of deaths and patient harm from January and February make distressing reading and show long ambulance delays continued beyond the festive period investigated by an external review.

The external review concluded that the pensioner had not died “as a direct consequence” of the long delay. Indeed, it concluded that not one of the 22 serious incidents it reviewed had died because of the long delays.

But whether the elderly stroke victim would have died anyway really comes down to luck of the draw. An 18 hour 44 minute wait for a 999 call from a 91-year-old describing stroke symptoms, is, as one trust insider decided put it, indefensible. Whatever the eventual outcome.

Of equal concern for system leaders should be that the East of England Ambulance Services Trust’s performance appeared to be deteriorating in May and, as HSJ understands from internal trust data, into June as well.

This follows system leaders and the Care Quality Commission having convened a risk summit in February to improve performance.

No one expected the risk summit to be a magic bullet, or for the trust’s grave problems to be addressed overnight. The trust has long standing capacity issues, both in terms of its ambulance fleet and paramedics to staff them.

And, ultimately, it’s the trust’s leadership which is ultimately responsible for its performance.

But, four months on from the risk summit, with waiting times problems persisting during the least stressful part of the ambulance calendar, it is fair to ask what improvements, if any, has the central intervention achieved?

Children get a raw deal from STPs

New analysis has revealed that almost one in four STP regions are failing to make clear commitments to improve services for children and young people suffering poor mental health.

An analysis of all 44 sustainability and transformation partnership plans by the charity YoungMinds, and shared with HSJ, examined areas based on how visible their plans were for supporting children and young people with poor mental health.

YoungMinds branded the findings “disappointing” and said it was crucial the national targets for CYP mental health services set out in the two reports were prioritised.

It has also said STP plans should be refreshed to make clear commitments to improving young people’s mental health.

But NHS England dismissed the analysis as “out of date” and said it did not investigate how effectively services were being transformed at a local level.

However, it is arguably hard for the public to analyse how well children and young people’s mental health plans are being implemented on the ground if those plans have never been published.