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

Culling the list

When the global digital exemplar programme was announced in 2016, there were complaints it was picking a few winners and leaving the rest of the ramshackle NHS IT estate behind.

Now, NHS England’s programme of giving a cadre of digitally capable trusts (or “exemplars”) hundreds of millions of pounds to show other trusts how digital is done is itself at risk of being left behind.

Several well-placed sources have said the £200m new wave of “digital exemplar” trusts, promised by the health and social care secretary Matt Hancock in September and scarcely heard-of since, is not coming. One source suggested the GDEs programme has “done its thing” and the money would instead be distributed like any other capital.

There are now significantly more central tech projects than money to pay for them. HSJ has been told, as the new central tech unit NHSX culls the list, new GDEs are among the most likely to go.

There are a few reasons why GDEs might be a likely candidate for the cut.

First, the programme was led by NHS England deputy chief executive Matthew Swindells and was incumbent IT supplier heavy, an approach to which Mr Hancock is hostile. Mr Swindells’ departure in July, and the ceding of his IT powers to NHSX, make it politically easier to drop it.

Second, a lot of money has already been spent on the GDE programme (with more locked-in for the next two years). Among the few winning exemplar trusts, there has been enough improvement to date from this investment to call it a success and move on.

And third, the bit where the exemplar trusts show everyone else how digital is done has been slower and harder than originally hoped. Now might be a good time to declare success and move on.

Whatever happens, there remain large parts of IT estate across NHS providers that is in no better a state than it was when the GDE programme was launched. If the GDE programme quietly wound down, whatever replaces it will still need to finish that job.

A rarity

A coroner has taken the unusual step of fining a trust chief executive. The £500 penalty issued to the Isle of Wight Trust boss, Maggie Oldham, was for failing to respond to a Schedule 5 notice, which gives coroners the power to compel someone to appear at a hearing or produce documentary evidence.

Isle of Wight Trust was meant to provide serious incident investigations relating to hospital deaths. The special measures trust, which is tackling a backlog of investigations, failed to do so before the coroner closed inquiries into hospital deaths. The provider has stressed it has overhauled its processes and is making progress clearing the overdue reviews.

According to Simon Turner, a partner at law firm Weightmans, such an action is “surprising” because “most coroners and their respective trusts enjoy effective working relationships”.

He continued: “It would be rare in our experience for such a fine to be levied against a trust. Not least because coroners do not tend to issue Schedule 5 notices until after they have made previous requests, which have not been responded to or complied with.”

Even then, Mr Turner said, the threat is usually enough to spur action before a fine is dished out, “given the potential reputational damage for an organisation failing to comply, not to mention the potential damage to the organisation’s professional relationship with that coroner”.