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

Chinese expansion

University Hospitals Birmingham Foundation Trust has joined a growing group of hospital trusts leveraging the NHS brand to seek revenue abroad.

HSJ reported that, earlier this year, the trust’s then-chief executive Dame Julie Moore met with several senior folk in the Chinese health system to explore business opportunities for the trust.

This included a “very influential” chair of a Beijing general hospital, who agreed to help the trust “penetrate the Chinese market”.

Major hospital trusts have been pursuing commercial opportunities overseas for years, most notably London trusts in the Middle East.

However, the focus is increasingly shifting to China, with UK healthcare exports to the country tripling last year to £363m.

This July, HSJ reported Northumbria Healthcare and the Christie FT were helping build 10 new hospitals in China as part of a Northumbria consortium.

Power play

NHS England’s power and influence over the health service is growing. The government is focusing its investment on NHS England’s budget, leaving NHS Improvement looking increasingly subservient to the commissioning body.

The system has been asking for fewer voices and clearer direction, but has NHS England taken this too far in its latest move to impose new approval processes on the production of national clinical audits?

Under the new rules, NHS England says it wants to deliver timely, accurate and consistent reports. Clinicians, however, have raised concerns NHS England is now seeking to “instruct” authors on the length of their reports and the number of recommendations.

The national clinical audit programme covers 40 topics looking at the most prevalent diseases and conditions. Crucial to their success is the ability to collect data and deliver honest evidence-based reports without fear or favour to help drive improvement.

Being told by NHS England – which is massively conflicted whenever an audit might criticise the health service – how to structure reports and the number of recommendations has to be an interference in what is a clinically independent process. A clinician who works on one of the national audits described the move as an “unprecedented power grab”. 

And, as the lead for the maternity audit programme made clear in her leaked email, the danger is this looks like an attempt to massage difficult messages and control what is being said. That can only reflect badly on this country’s reputation for robust independent clinical audits.

Pass the P45

A new survey from trade union Managers in Partnership has highlighted NHS workforce pressures extend beyond clinical staff.

Of the trade union members who were planning to depart the NHS in the next five years, 60 per cent blamed changes within the NHS weighing on their job satisfaction as their reason for seeking out their P45. A smaller, but still significant, proportion of respondents blamed high workloads and the havoc work was playing with their health. 

Applications for their replacements may not be particularly forthcoming, as the survey also found the majority of NHS managers would not recommend the career choice to their friends and family.

Union chief executive Jon Restell explained a combination of high pressures on services, reduced resources and organisational change was behind managers’ dissatisfaction. He added the long-term plan could be an opportunity to boost managers’ morale.