The must read stories and talking points from Friday

Pioneers mired

An independent study of the Department of Health’s integration pioneers programme (remember that?) has found it has so far yielded few tangible improvements to services, and failed to remove structural barriers to joining up care.

Before the vanguards, the pioneers were supposed to be the exemplars of integration, with national support to go further, faster, and light the way for the rest of the country to follow.

The DH’s own commissioned evaluation found the first wave on the whole didn’t get very far in the first 18 months after they were awarded pioneer status. National policy barriers were not removed and there were competing performance and financial pressures.

Norman Lamb, the Liberal Democrat former health minister who set up the initiative, has publicly criticised NHS England, whom he says never took the programme seriously enough. And, he says, he now worries that the relentless focus on balancing the finances has made integration a “second order priority”, with crisis management taking precedence in order to prop up a dysfunctional system.

The evaluation has a term for this: the “integration paradox”, in which the very things that make integration necessary (financial and operational pressures), are the same things which prevent it being implemented.

While the vanguards have had more central resource in terms of money and manpower than the pioneers ever enjoyed, the same risk applies.

Junior doctors: Yet more stats

One of the central controversies in the junior doctors dispute has been Jeremy Hunt’s claim that lower staffing rates cause a “weekend effect” leading to increased mortality rates. Both sides argue they have the stats to back up their position.

While the BMA and Department of Health were flirting with the idea of thinking about maybe considering new talks at the end of last week, a new research paper came out, appearing to boost the junior doctors’ case.

The study suggested the increased excess deaths was due to higher sickness and probability of admission. “Insufficient attention has been paid to whether it is the number of deaths or the number of admissions that is driving the elevation of mortality rates at weekends,” the authors wrote. “When we relate the numbers of deaths to the numbers of patients attending A&E, the death rate is lower at the weekend. The weekend effect is only apparent in the subset of patients who are admitted to hospital. This raises the possibility that the weekend effect is a statistical artefact caused by admissions being restricted to sicker patients at weekends.”

Does this change anything? Well, it’s hardly the first or only report on the subject, and political arguments are rarely settled by a single piece of research.

And, while important, deaths aren’t the only issue. Many reports by many bodies over many years show that irrespective of mortality there is a clear case to improve services for patients who survive their weekend stay in hospital.

Only willing provider

On Friday commissioners in the South West announced that an NHS-led consortium was the only bidder to have been taken through to the next stage of a procurement for children’s community services in Bristol, South Gloucestershire and North Somerset.

The fact that only one bidder was taken through from the pre-qualification questionnaire stage might raise some eyebrows – the commissioners say that the consortium was the only bid which met its criteria.

It would be interesting to know how many organisations submitted bids in the first stage, but the commissioners claim they can’t disclose this information until the procurement has finished.

In any case, the fact that a not-for-profit NHS consortium is the only bidder will go down well with a vocal section of the local community – Bristol was a focus of “anti-privatisation” campaigning when Virgin Care were shortlisted last year for the interim contract.