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

Screening misunderstanding

In May, the secretary of state stood up in Parliament and apologised. He said the national breast cancer screening programme had lost track of anything up to 450,000 women who were never called for their final test. Apparently an algorithm had gone askew, affecting the computer systems used to invite women to be screened.

But it now seems that conclusion was premature. A report by management consultants PwC for Public Health England says a misunderstanding was responsible for the incident, along with weak governance and loss of “corporate memory”.

The algorithm was largely blame free, the consultants concluded. Instead, a small but significant mistake made it into a new national specification for the service, drafted in 2013.

It said women would receive their final screen at the age of 71. But that is not how the programme works. Women are invited in batches based on the year they are born, not their actual age. The first invitation goes out in the year a woman turns 50, 51 or 52. They get six subsequent invitations every three years. So, some women will get their first invitation in the year they turn 50 but while still aged 49. Therefore, some women will get their final invite aged 67.

Because few people at PHE had a granular knowledge of the programme, senior management did not realise their alarm at an apparent system failure was based on a misunderstanding, not a fault.

The misunderstanding apparently stretched into the patient notification exercise too, which was sent to women aged 68 to 71 who had not been invited for a screen. It is still not clear how many of the women have actually been lost track of in the system.

Back to south London

It may only be an interim role (so far) but the appointment of Matthew Kershaw to the chief executive role at Croydon Health Services Trust is potentially significant.

For a start, Mr Kershaw was one of two chief executives very publicly moved on by Jeremy Hunt last year after declining accident and emergency performances. The fact he is back after a stint at the King’s Fund could be a sign that a new health secretary means a new start for some casualties of the Monday morning meetings, an arrangement Matt Hancock has discontinued.

Whatever the wider import of the move, Mr Kershaw’s appetite for difficult jobs cannot be doubted.

Before East Kent and its difficult mix of staffing and reconfiguration issues, he led Brighton and Sussex University Hospitals Trust. The employment tribunal judgements to later come out of that trust make clear how fraught the governance at the organisation could be – on top of all the other problems faced by a large teaching institution.

Before that he led the failure regime process at South London Healthcare Trust, a process condensed into a ludicrously tight timeframe and that involved facing some degree of intimidation from protestors.

Compared to that, running the Departmnt of Health and Social Care’s doomed foundation trust pipeline must have seemed comparatively easy.

Five tests for 10 years

With recess and summer almost already a distant memory, NHS Providers launched its latest lobbying effort on the long term plan, setting out five tests around focus and deliverability.

NHSP said the plan must:

  • be centred around patients and their carers;
  • be realistic and deliverable;
  • be underpinned by a credible workforce strategy;
  • lay the groundwork for a sustainable high performing service; and
  • support local good governance, autonomy and accountability.

The tests appear fairly motherhood and apple pie on first read. But considered in the broader context of recent NHS policy formation they are a good benchmark to gauge the new plan on.

Not least in terms of realism: the NHS has all too hastily signed up to asks it has largely known would be undeliverable in recent years (like pledging to meet a number of key statutory performance targets, including the four hour target this year).

This has seen growing distrust from the government and given a false impression about how deep the NHS’s financial and performance problems were.

System leaders must resist the urge to try and impress their Whitehall counterparts, especially with a new health secretary in post. They must instead ensure everyone, politicians and public alike, remains completely sighted on how much can be achieved by what is a modest funding increase in relative terms after so many years of austerity – even if it’s sold to the public as much more.