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

Something to ease the pain

Being made redundant is never pleasant, even for those leaving under the NHS’ relatively generous redundancy terms.

HSJ has discovered 33 clinical commissioning group staff have left with at least the maximum pay out of £160,000 over the last three years. Around a third of those left with a little bit extra to ease the pain of parting – generally pay in lieu of notice of up to £60,000. 

CCGs were swift to point out these additional payments were in line with terms and conditions but it does raise the question of why senior staff were not working out their notice.

There are some cases where immediate removal is necessary – “black bag” departures are common in the City, for example, where the departing employee will arrive at work to find their personal belongings in a black bag before being escorted off the premises. But departures of NHS senior managers tend to be more civilised and those involved in these cases would have been aware redundancy was looming.

Moreover, these are skilled and experienced staff who could have contributed during that notice period, whether at their own CCG or seconded somewhere else on limited time projects. Whether this was considered is not known, but many seem to have left months before their notice period would have expired.

Many of these redundancies were linked to CCG mergers or the appointment of joint management teams. With another round of CCG mergers certain in 2020, the NHS could face more high cost redundancies. Perhaps it will be an opportunity to reflect on how best to use the skills of staff who are earmarked for redundancy.

Must do better

The Care Quality Commission has delivered its annual state of care report which made for grim reading for health and social care secretary Matt Hancock and NHS England chief executive Simon Stevens. The watchdog made clear the pressure on hospitals from an underfunded social care system and poorly designed community and mental health services was leaving millions of patients facing poor care.

Chief inspector of hospitals Ted Baker was explicit during a press conference on Monday that the “ever open” doors of emergency departments were naturally the option chosen by families when other services could not meet their needs.

Add to this the fragmentation of care, the dire workforce shortages affecting health and social care, and the near decade squeeze in funding and it’s no surprise that the CQC felt the need to warn of a perfect storm.

Reading between the lines in the report, what emerges is a failure of commissioning, government policy and providers’ own responsibilities for redesigning care. While the CQC alluded to this, it avoided coming out and delivering a punch to the nose of either the Department of Health and Social Care or NHS England.

While the CQC has no role to regulate commissioners or government, if it cannot find its voice to target the real decision makers, it risks such reports achieving little.

On the basis of the state of care report, the Five Year Forward View has failed in its bid to create care models up to meeting today’s demands.

If the long-term plan is to avoid the same fate, then both the CQC and NHSE must do better.