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

Flexible ban

The poor standard of inpatient facilities is one of the most pressing issues facing both mental health and learning disability services. For years, many patients have had to be sent hundreds of miles across the country to receive care.

And a new revelation from East Anglia — of NHS England sending a patient to a hospital which already had a voluntary ban on new admissions — appears to highlight the dearth of options available to patients and commissioners.

Jeesal Cawston Park in Norfolk had already agreed to a ‘voluntary embargo’ on new admissions with commissioners after a Care Quality Commission report branded the facility “inadequate” in July last year.

CQC inspectors revisited the hospital for people with learning disabilities and autism in November and decided upon immediate action to ensure the restrictions on admissions had legal force.

Inspectors still had “serious concerns” about Cawston Park, and now the facility cannot legally take on any new patients without the CQC’s written permission.

But just days before the CQC made this judgement, NHS England specifically asked the hospital to take in one patient — despite the voluntary admissions ban and the “inadequate” rating.

The November report, which was published late last week, revealed the CQC found wards were short-staffed and general observations were not always being done.

Inspectors also found an unbagged stool sample in a medication fridge. The stool sample, which had been in the fridge for more than two months, had not been spotted during a check on the fridge in October.

Jeesal said the new patient is an “exceptional case” and its clinical team felt the admission “was in the best interest of the patient”.

NHSE, meanwhile, said it “always” works with patients’ families “to decide on the most appropriate place for their needs”.


The five integrated care system chairs appointed to London possess a good combination of lots of different skills, and come from a variety of backgrounds.

However, announcing that a senior partner at McKinsey was to be one of them, without noting she was also in the process of retiring her current role, raised a fair few questions.

Penny Dash is hugely experienced and respected in the sector but it was odd of NHS England and Improvement London to announce her and other appointments without an actual starting date.

The regional director’s office has still not said when Dr Dash and her colleagues will start in these key roles across the capital.

Plus, the assurances it offered about there not being a conflict of interest in any overlap between the end of her McKinsey role and start of her NHS one have not been altogether reassuring.

The perception of a conflict of interest can be just as important as an actual one and should be avoided — other consultancies bidding for work against Jermyn Street feel they will be at a disadvantage during any “overlap”. (Yes, we know they’ve actually moved, but they’ll always be associated with Jermyn Street — it was always so convenient for Whitehall.)

Dr Dash’s appointment to the ICS role in north west London is also interesting in that McKinsey has done a lot of work in that corner of the capital over the past 15 years (at least). Around £34m’s worth, if you’re counting. 

It will be interesting to see Dr Dash’s take on the challenges facing the patch, and whether she resiles from the view of her employers about the potential for reductions in hospital bed numbers.

McKinsey had a lot of input on the Shaping A Healthier Future programme, which was formally rejected by NHSI in 2017 then formally ended by Matt Hancock last March.