The essential stories and must read debate in the NHS

An inspector won’t call

The Care Quality Commission has taken the unprecedented step of suspending routine inspections of hospital trusts during January because of the pressure on trusts this winter.

The move drew criticism from some staff who pointed out that the regulator was there to monitor and ensure minimum standards of care are not breached.

Chief executive Sir David Behan said: “To support the system as much as possible, we are rescheduling some routine inspections of services. This is to allow frontline staff and leaders to focus on continuing to ensure that people receive safe, high quality care during this period of increased demand.

“However, inspections scheduled in response to concerns about quality or safety will go ahead as planned. These include those that are in response to new information, as well as those to follow up on previously identified concerns… We will continue to monitor performance very closely and will act to protect people if necessary.”

NHS wish list

The next few weeks should see the setting of new marching orders for the NHS in the form of revised planning guidance from NHS England and NHS Improvement, and a refreshed NHS mandate from the newly renamed Department of Health and Social Care.

The ask of the NHS is always a matter of substantial debate behind the scenes, even when money is flowing, but is particularly in the spotlight this year: NHS England has said the service can’t meet all the current basic targets and improvement asks within the current resource envelope. It even raised the spectre of the government having to legally remove the NHS constitutional expectation of elective waiting times within 18 weeks – suggesting that, otherwise, there may be legal challenges.

The outlook of patients and the public on this – or at least, what they have told Healthwatch England – is not straightforward.

Healthwatch is, beyond NHS England, the only body the DH is required to ask about the mandate. In its official submission – shared with HSJ – it has indicated that retaining the flagship targets in their current form is not the be all and end all.

They could be flexed – more important is a proper understanding of what this is doing to care standards in the round, particularly patients’ experience.

In that vein, Healthwach says it wants the NHS to up its game on experience of discharge from hospital, and care after this, particularly transfers around the system; and use of complaints and feedback on these to patients. It highlights mental health and dentistry access as priorities in need of more oomph. And says better involvement is still needed with Sustainability and Transformation Partnerships.

In the great NHS prioritisation debate, perhaps all this justifies putting planned care lists on the back burner, when the alternative is failing to build up mental health and primary care. Given the status of targets in media and politics – as well as NHS operational management – we suspect this subtlety may be lost as debates over the mandate and delivery rumble on.

High reward

NHS England is preparing to announce a new wave of funding to expand treatment for some of the most high risk mental health patients and safely integrate them back into the community.

HSJ understands the national commissioning body will give providers the chance to bid for up to £1.2m each to set up new specialist forensic community mental health teams.

These teams work with some of the highest acuity patients who have committed crimes and often spent time in prisons or high secure mental health units.

The new teams aim to help patients to exit inpatient units and safely integrate back into communities, reducing bed occupancy and hopefully reducing out of area placements.

NHS England sent an email to providers alerting them to the new cash, and is expected to have high level conversations with trust leaders this month. After this, the bidding process is expected to be opened.

But many questions remain around the plans, including whether it is new money and where the cash is coming from. It could come from the promised Five Year Forward View for Mental Health pot for secure or community, acute and crisis care, or from other budgets, or completely new money – it is still not clear.

We do not know how many areas will be chosen to receive the cash so, therefore, it is unclear how big the total funding pot will be.

Nonetheless, the proposal to set up new teams has been welcomed by the Royal College of Psychiatrists and mental health leaders, even if the details and timings have not been completely ironed out.