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

An interesting industry

Patient transport is an industry which people shake their heads about.

One of the least glamourous parts of the health system, it seems to have no small amount of dysfunction in its commissioning and provision. Leaving aside the actual inconvenience to patients of a poorly-functioning service, this also has a significant effect on the functioning of hospitals.

Being unable to discharge someone from a bed because there is no way for them to get home has an obvious effect on flow through a hospital – all important, especially in winter.

Procurement experts point out the tensions between the clinical commissioning groups who commission on price and the users of the service (the hospitals) who want to extract as much value as possible. There is a lot of tension.

Sometimes the providers have not been made aware they are likely to see double the volume of patients on a Friday afternoon because there’s been a push to discharge.

Sometimes the providers will have tendered far too low for the work available.

Sometimes, as in this case, the fact the industry is made up of mainly of small and medium sized firms means there is some sketchy governance and resilience of services.

The NHS England commissioned report into the sector will make interesting reading.

Legislation for the new Health Services Safety Investigation Body — which was previously the Healthcare Safety Investigation Branch — does not include any plans to extend the current maternity investigations, which it took out of the NHS’ hands in 2018. The Department of Health and Social Care has subsequently confirmed HSIB will no longer do these investigations from 2021.

Former health secretary Jeremy Hunt has said he is concerned HSIB has not been asked to carry on with this work, given the scale of failure by the NHS to do these investigations well over many years.

Whether HSIB is the right body or not to investigate maternity incidents, it is clear there should be no return to the past where families were often excluded, information kept hidden and, in the worst examples, poor care was actively covered up.

If the government is to hit its target of halving stillbirths and neonatal deaths by 2025, it will need to ensure open and transparent scrutiny when things go wrong.