Daily Insight: Culture wars, NHS style

A “culture battle” is rumbling on within NHS England about how to drive recovery in urgent and emergency care, sources have told HSJ.

NHSE last week told systems to carry out self assessments on the “maturity” of their UEC services, and to appoint “recovery champions” to drive improvements.

This is part of a “universal offer” from NHSE to all systems under its urgent care recovery scheme – in which some struggling integrated care boards are placed in “tiers” of intervention.

This “universal offer” is a joint project by NHSE’s “integrated urgent and emergency care” teams and the “elective and emergency care improvement support team”.

Sources said this was indicative of an increasingly “top down”, “performance management” approach from NHSE – or as one put it, “whipping the dead horse harder”.

However, a source close to ECIST, and NHSE, have insisted ECIST’s work is collaborative and the “universal offer” has been developed and implemented by clinicians.

Digital mediocrity

Back in 2021, national leaders in the NHS began working on a new way of measuring “digital maturity” across the health system after recognising that the previous system was not cutting the mustard.

The last assessment – carried out in 2019 – relied purely on organisations self-assessing, which led to accusations that some providers were “gaming” the system by rating themselves poorly in an attempt to secure more central funding.

Thus, at the start of this year, consultancy firm McKinsey was handed a £6.7m contract to help devise and carry out a new digital maturity assessment that would provide a greater level of validation against the seven measures outlined in the “What Good Looks Like” framework.

It is the first time that integrated care systems have been rated on their digital maturity, having only been established last year.

The results, seen by HSJ, paint a middling picture. No system is particularly excelling but there are those performing better than others – just three ICSs scored a 3 or 3.1 on a scale from 1 to 5.

Notably, Northamptonshire ICS was the worst performing system, having scored a 2.2, while a group of neighbouring systems in the west and south west scored poorly at 2.3 or 2.4.

Suffolk and North Essex, Frimley, and West Yorkshire were the highest performing ICSs, while the North East and Yorkshire was the best performing region on average.

NHSE has confirmed that the assessment will be carried out annually to track progress and help decision makers allocate resources.