The must-read stories and debate in health policy and leadership.
- Today’s problem solver: Trusts hired behavioural psychologist to resolve differences between medics
- Today’s amended timetable: Controversial stroke plans delayed
Election day has dawned and protestations of love for “Our NHS” have reached Gollum-esque levels of intensity.
The 2019 election will be remembered as one in which the NHS featured more prominently than in any election other than 1945 and, arguably, 1997. Truth be told though, there has been little actual scrutiny of the parties’ plans for the service. The debate has been dominated by attacks on the other side’s record and increasingly sentimental claims from all to be “the party of the NHS”.
In the last few days the situation has improved a little, with a renewed focus on the NHS’ performance as it runs into what already feels like a difficult winter. But even here it has been a case of attack and defence, of gaffe and rebuttal — and not an exploration of how Labour or Conservatives would solve the problem other than in the broadest fashion (‘more money and staff’).
Proposed social care reforms, or the lack of them, have not been debated in any real depth — missing a key opportunity to socialise the idea of change with the British people. The nature of healthcare provision has largely been untouched — for example, what do people feel about the greater use of technology and are they interested in having a greater say, and involvement, in their care and the organisations who provide them? Air pollution, which impacts most on those already placing a significant demand on the NHS, has been almost totally ignored. HSJ could go on.
HSJ is — and always has been — politically neutral. But, an analysis of the parties’ proposals does suggest Labour has the best offer “on paper” for the NHS financially and — even more significantly — for those cash-starved areas of public service such as housing, welfare and social care whose work is vital to managing demand for expensive health services. Against this, the sheer scope of Labour’s ambitions raise questions of deliverability and affordability, as does its “democratic” process of policy making.
One extra uncertainty that would follow a Labour victory is the strong likelihood of Jonathan Ashworth not being the health secretary after his betrayal by a friend who leaked a private phone conversation critical of Jeremy Corbyn and the party’s election chances. Mr Ashworth is widely liked and respected in health leadership circles and his sacking would be a cause for dismay.
Then there is the small matter of Brexit. Again, HSJ hopes it is not overstepping the neutrality line, if it comments that not one authoritative independent body has suggested that leaving the EU — especially without extensive arrangements in place for cooperation — is anything other than negative for the NHS authority (whether economically, clinically, or from any other standpoint).
There has been much talk of getting things “done” or “sorted” in recent weeks. Whatever the result of the election, many of the big questions that will decide the NHS’ fate have yet to be answered.
STP’s knuckles rapped
There is nothing unusual about health economies raising their response level to the highest category of escalation when pressure on services ramps up.
But one such incident in Bristol, North Somerset and South Gloucestershire created a stir when a regional director with NHS England/Improvement’s team warned he had “serious concerns” about the way local leaders had responded.
In a knuckle-rapping email, seen by HSJ, Mark Cooke, NHSE/I’s director of strategy and transformation in the south west regional team, told a local community care chief executive that the region had not approached the OPEL 4 system response procedure in the nationally agreed way.
For example, the region did not appear to have informed NHSE/I’s regional director Elizabeth O’Mahony it was escalating to OPEL 4.
After listening to a phone conference (dubbed a “gold command call”) with local leaders, Mr Cooke also said participants had failed to address any risks of harm to patients and he bemoaned the “lack of senior presence” on the call.
He went on to say managers on the call had taken a “tactical if not operational approach”, but also highlighted a lack of strategic focus.
Licking its wounds, the health economy subsequently lowered its OPEL level from 4 to 3 the next day. Its clinical commissioning group has made changes to the escalation process, but it declined to share details of them with HSJ.