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

The people have spoken

More than 160,000 people have told NHS England via an online campaign survey that they want the law changed “so that contracts to run NHS services no longer have to be put up for auction”.

The submissions from 38 Degrees come as NHSE seeks to build pressure for politicians to support its proposed changes to legislation, which include seeking amendments to “free the NHS from overly rigid procurement requirements”. The details of views from within the health sector so far have been mixed, though most say they agree with the thrust of limited changes to the law.

The website – which has hosted several popular campaigns on NHS funding and private involvement in recent years – invited its registered users to fill in a survey, whose responses have been submitted to a call for views by NHSE. 

Some will doubt whether it holds much validity as a response, since the respondents are self-selecting and 38 Degrees followers have generally taken this sort of view since the Health Bill rows of the early 2010s.

Yet it’s a very large number of people, without a great deal of publicity about the legislation issue so far – and may be seen as a signal of how far public opinion, particularly with the Labour party well and truly attached to the left, has swung away from competition and outsourcing in the health service.

NHSE is pleased with the level of engagement it has seen (it also discussed the proposals at its new “NHS Assembly” creation last month) but it’s yet to be seen quite how it will present the 38 Degrees responses.

The prime minister formally invited the NHS to come up with legislation proposals last summer. However, to have a chance of making it reality, NHSE needs to persuade politicians it is worthwhile pursuing this – despite their Parliamentary and Brexit logjam – and keeping it on track.

The health and social secretary has said he will back it, but also indicated it will rely on Labour and others refraining from trying to amend a proposed bill. This seems incredibly unlikely. With the Commons hung in political balance, if a bill does come forward the temptation will be irresistible for someone to move, for example, the “NHS Reinstatement Bill” which has been championed by many Corbyn allies; more stringent constraints on competition; or legally mandated nurse staffing numbers.

Either way, there are some signs of the debate getting moving.

Left in limbo

“Success has many fathers while failure is an orphan” is as true of the NHS as other walks of life – successes get talked about but organisations are often silent about problem areas.

This seems to be the case with the child and adolescent mental health services new model of care planned for Surrey, Sussex and Kent. NHSE announced a planned start date in 2017 which slipped to 2018 before being quietly shelved.

There are good reasons for this. The lead trust – Surrey and Borders Partnership Foundation Trust – sits on the boundaries of the region and seems to be looking for partners elsewhere. With only one other trust involved, it was looking to the area’s private providers to help provide more inpatient care closer to home.

Cygnet Health Care was probably the biggest provider of inpatient CAMHS among those partners but it has closed one unit after quality concerns and has seen another heavily criticised. Priory Healthcare has also recently been fined over the death of a teenager in one of its units. While Elysium Healthcare has an adolescent eating disorders unit in Brighton, the remaining partner – Huntercombe Group –  has no CAMHS inpatient services in Kent, Surrey and Sussex.

This may have limited the help private providers could have offered, but the planned partnership’s demise leaves services in Kent and Sussex in limbo with no real alternative to sending some young people out of area – especially from Kent. Other partners may come forward but it’s hard not to see the last three years as a wasted opportunity to deliver change.