The must read stories and talking points in health policy

Another special measures regime

It remains to be seen whether a new “special measures” regime for A&E and other performance measures will be more than an exercise in naming and shaming, but NHS Improvement is right (up to a point) that a small number of trusts are responsible for a disproportionate amount of the worrying decline in A&E performance.

HSJ analysis shows three trusts responsible for 2.7 per cent of attendances in Q1 were to blame for more than 10 per cent of the growth in breaches of the target year on year.

Of these, Barking, Havering and Redbridge University Hospitals Trust have long had problems; Nottingham is a surprise disaster; and the leadership has already changed at North Middlesex.

But even without the 40 worst performers, the slide in Q1 would still have been 1.4 percentage points, more than previous years.

Only 25 of this year’s 40 worst performers were in last year’s 40 worst performers – which would be a sign of progress if performance had improved, but it has got significantly worse (it would look two percentage points worse without urgent care centres).

Kudos to Hull and East Yorkshire Hospitals Trust though, a significant investment in staff and buildings saw it rocket out of the bottom five.

NHS Improvement already offers plenty of support to trusts – the Emergency Care Intensive Support Team for one, and Pauline Philip’s A&E Improvement Plan looks genuinely innovative – so it is interesting that some trusts are being considered for a new form of punitive action.

It is not known what being placed in this version of special measures would entail, but earlier this year five trusts were placed in a new “financial special measures” regime. How many naughty steps can NHSI and the DH invent for trusts before it builds a whole staircase of failure?

Stevens: new contract rules coming

System leaders are drawing up new rules for NHS bodies tendering large contracts in response to the disastrous collapse of a £750m deal last year, Simon Stevens has told MPs.

The NHS England chief executive also told the Commons public accounts committee, which was taking evidence on the collapse of the UnitingCare Partnership older people’s contract, that procurement rules could change as a result of Brexit.

He revealed a new checklist for commissioners would be published next month, and a new assurance process for providers is also being developed.

He also spoke publicly for the first time about the decision last month to disband the NHS’s internal commercial advisers the Strategic Projects Team, stating he had “not been satisfied with the quality of their work”.