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

User error

For an obscure IT project, the future service programme has caused a lot of trouble for those charged with overseeing the NHS.

For the sum of £75m, Atos has provided IT services to the Department of Health (and, latterly, Social Care since 2012, and, over time, NHS England, NHS Improvement, the Care Quality Commission, and Health Research Authority.

But, in 2017, these bodies got together and started planning what to do when the contract with Atos expired – with no possibility of renewal – in April 2020. Thus, the future services programme was born.

Progress was slow at first. But when Matt Hancock arrived at the department last July, among the first things he did was order a review of the programme and suggest that using Google would be more sensible (and cheaper).

The Care Quality Commission has been demanding changes and more haste since April last year – to little effect. In October, the regulator ordered an independent review of the programme. The review recommended urgent changes to avoid a costly extension of the Atos contract, which would violate procurement rules.

When the CQC felt NHS England and other partners didn’t take the review to heart, it quit the programme in November. Upon departing, it sent its soon-to-be-former-partners a letter listing the programmes failing, including poor governance, no exit strategy, and slow decision making. It also suggested it might be best if the programme were abandoned entirely.

NHSE, instead, doubled down and signed a multimillion-pound contract with a recruiter to find more staff to run the programme and is insisting everything is now going very well indeed. The programme has even taken on Mr Hancock’s suggestion and will include Google products.

Meanwhile, HSJ also revealed this week the CQC will slash its budgets to fund its own IT refresh.

That programme was given a red rating for risk in February, but the CQC has said it is set to improve.

Six months on

It is exactly six months since HSJ broke the news that the government had taken action against Healthcare Environmental Services for stockpiling hundreds of tonnes of waste – including human body parts – from NHS hospitals.

The fallout was rather spectacular.

Trusts were told to move to a rapidly-negotiated contingency contract with Mitie, HES and the government became locked in a bitter (and public) war of words, and central NHS chiefs realised clinical waste needed far more attention than it had been previously been afforded.

Half a year later, the sector is still reeling from the demise of one of its biggest players. And, unfortunately, the problems are far from over.

HSJ today revealed a number of trusts have warned NHS Improvement about problems with the collection and disposal of their waste, forcing some to implement contingency plans, such as storing waste on-site in temporary containers.

NHSI has escalated the issue to NHSE’s national team for emergency preparedness, resilience and response, while both the Environment Agency and Department for Environment, Food and Rural Affairs are helping the Department of Health and Social Care manage the issues.

The national contingency plans, which include granting dispensations so that unlicensed trucks can transport waste to unsuitable incinerators for disposal, face potential disruption as several waste facilities have closed their doors due to maintenance in April.

And while trusts grapple with the amount of waste piling up across their sites, salt is being rubbed into the wounds by the extra costs forced upon them by the Mitie contract.

Steps are being taken to improve the way the NHS procures clinical waste contracts in future, but the HES saga is still casting a long shadow over the NHS.