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

The safety of accident and emergency departments is often questioned – but are rarely laid bare in the way that of Basildon Hospital’s was in 2018.

An invited service review carried out by the Royal College of Emergency Medicine found the inability to move patients out of the department into beds was a “significant safety risk” leading to overcrowding.

Too few consultants – especially at weekends – meant the department was dependent on middle grade doctors while more than a third of band five nurse posts were vacant. Ambulances had to wait to offload patients – up to two and a half hours on the day the reviewers visited.

All of this is possibly not too much of a surprise to HSJ readers but may have come as a shock to the people who use the A&E and doubtless local MPs and councillors, and governors of the trust.

Except they are unlikely to have known what was going on. Like so many royal college reports, this one was not published. It was discussed but apparently not by the full board in public and was instead considered by a committee.

Mid and South Essex Foundation Trust, which now runs the hospital. says the issues identified have been addressed – although it still seems short of consultants. But with the merger of several trusts, it will be hard to see what the performance of this individual A&E is going forward.

Secrecy part two

One of the authors of the NHS People Plan has shed light on the mistake which meant the report appeared to imply that being lesbian, gay, bisexual, transgender, queer or questioning was equivalent to having a disability or long-term condition.

Andrew Foster claims NHS England/Improvement’s “insane secretiveness” in the lead-up to publication meant that “very few people saw full drafts of the People Plan, only being shown their “own” sections. Had it been more widely checked, this terrible mistake would have been spotted”. 

Mr Foster was asked to take charge of the leadership stream of the People Plan after he retired as chief executive of Wrightington, Wigan and Leigh FT.

He went on to say that the plan “is limp on equality, diversity and inclusion when this was the greatest opportunity ever to start a real sea change. Similarly, the messages on leadership culture sit somewhat at odds with the style of leadership that has often been on display in and by national bodies these last few months”.

Work to make the NHS a better place to work will be less relevant if it continues to be understaffed, he added.