The must-read stories and debate in health policy and leadership.
On a day when one bombshell story is guaranteed to dominate the media agenda, it’s always interesting to note what else gets sneaked out.
Late on the afternoon of Dominic Cummings’ marathon appearance in front of MPs, NHS England decided this was the right moment to announce that, following a consultation, they were forging ahead with a long-held plan to replace the NHS’ four-hour emergency target with a new set of 10 metrics.
The story was predictably pushed way down the running order for national media outlets, who on less exceptional days would have paid significant attention to the NHS taking another step towards ditching its main performance metric.
The need for such an approach to the announcement appears, on first glance, puzzling.
The desire to move from the totemic four-hour target to a more nuanced regime has the backing of the Academy of Royal Colleges, the Royal College of Emergency Medicine, and patient representative groups including the Patient Association, among a long list of others. So why bury it?
But what has not yet been decided is how the new bundle of 10 metrics will be used to measure performance for accountability, rather than clinical safety. There is also no plan yet for how performance against the new system will be comparable with previous years.
The four-hour target has long been viewed as too blunt and as having an overbearing effect on performance management. So, a move to a more nuanced basket of metrics appears reasonable.
But without a plan for how the basket will be used to hold individual organisations and the system as a whole to account, the job feels only half done.
With the NHS and stakeholders signed up, the ball is now in the government’s court. Whatever happens in the next phase of the process, a proper, open discussion about how decisions around accountability will be made is the least NHS managers, clinical staff and patients deserve.
Guilty as discharged?
Matt Hancock spent most of Thursday’s covid press conference defending himself from Dominic Cummings’ allegation that he lied back in March by claiming that patients being discharged from hospital to care homes would all be tested for covid.
The fact is at the time, through March and into April, this was often not happening, and the official guidance did not require it — no doubt the rules followed from the lack of test capacity and desire to clear out hospitals to prepare for an enormous wave of acutely ill covid patients.
At the press conference Mr Hancock said: “My recollection of events is that I committed to delivering that testing when people coming out of hospitals to care homes when we could do it. I then built that capacity.”
When asked why he signed off on the discharge guidance when testing capacity wasn’t in place, he said he listened to “scientific advice”.
This may well be the health secretary trying to dodge a bullet, but it reminds us that back in March 2020 the NHS was so terrified by scenes in Italy of an overwhelmed health system, that clearing acute beds was considered the overwhelming priority.
In another twist of convenient timing, Public Health England published analysis on Thursday which appeared to confirm that hospital discharge was NOT the biggest reason for infection spreading to care homes — while indicating it was a very tricky thing to establish.
Mr Hancock also referenced his target of reaching 100,000 covid tests a day by the end of April – also attacked by Dom, and which HSJ revealed at the time was only achieved through counting tests that were posted out but had not been returned, and not necessarily even used.
He linked building testing capacity to this 100,000 target, saying capacity only grows when government sets a tough target to reach. He may come to regret his subsequent claim that with limited testing capacity, these tests had to be “clinically prioritised”.
Many felt at the time that the 100,000 target in fact skewed priorities, as Mr Cummings alleged, though it probably inspired action too.
With nearly every journalists’ question focused on the care home issue, the heat is not waning anytime soon, no matter how much he talks about the success of the vaccine programme. Let’s hope it puts a rocket up the government’s faltering social care reform promises.
Asked if he had spoken to Boris Johnson today, Mr Hancock said only: “I speak all the time to the prime minister.”
But with the new health and social care bill due to land in the Commons in coming months, and Mr Cummings’ ire aimed as much at Mr Johnson as at Mr Hancock, the health secretary will likely survive until at least autumn.
Parking up the wrong tree
In what is likely to be an unpopular decision, ministers are scrapping the free emergency car parking pass which NHS staff have used since the start of the coronavirus pandemic.
Recently updated government guidance said the pass would be withdrawn from 21 June, in line with the plans set out in the “roadmap”.
However, and what has already been pointed out, this comes against the backdrop of a new covid variant which threatens to dash ministers’ hopes of normality.
NHS staff may well not feel the most appreciated, what with a recommended 1 per cent pay rise on top of this latest announcement…