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

There’s a popular image of NHS senior managers as being ex-bean counters, usually male, who only care about the money.

HSJ readers know that is not the case and that staff from every conceivable background – accountants, of course, but also doctors, nurses and HR directors – have all made it to chief executive level.

Radiographers are pretty thin on the ground at the top though – but the new chief executive at Ashford and St Peter’s Hospitals Foundation Trust, Julie Smith, is from a radiography background and also has extensive experience in operations.

Ms Smith will take over a trust which has been led by Suzanne Rankin – a nurse by background – for seven years (Ms Rankin has recently left to run a health board in Wales). There will probably never be a definitive answer on whether those from clinical backgrounds bring anything different to the chief executive role but it’s certainly not the case that the top jobs are only open to those who have followed a particular career path.

How to help social care?

Efforts to get more hospital patients into stepdown beds and virtual wards continue to have no discernible impact on the numbers of “medically fit” who remain in hospital, writes Lawrence Dunhill in North by Northwest.

At the start of January, NHS England was telling North West leaders to cut the number of hospital patients who did not meet the “criteria to reside” from almost 2,000 to around 1,300.

Yet last week, the numbers still stood at well over 2,000.

It’s possible there are some recording issues here, as NHSE’s focus on the discharge issue could have encouraged hospitals to be more active in identifying cases. But even if we allow for an element of that, there’s clearly a lack of any significant movement.

Without major financial investment and expansion of the social care workforce, which still isn’t on the table, it’s hard to see anything changing dramatically.

Some local leaders have started to take matters into their own hands, with Northumbria Healthcare FT planning to set up as a direct provider of some social care services.

But this has drawn criticism in some quarters, so what else can be done? Read the full expert briefing here.


Also on today

The Primer offers a speedy rundown of NHS analysis beyond the shores of HSJ, while in our comment section, Alex Bax says the Health and Care Bill’s proposed structures and duties could herald a step change in our responses to the most excluded.