Daily Insight: Experience Hancock

NHSX: Open for business

The worst kept secret in NHS tech circles is now officially a thing, with health and social care secretary Matt Hancock announcing the formation of NHSX on Tuesday.

NHSX – we still don’t know what the “X” is for, but “experience” seems to be the favourite – is a joint venture between NHS England, NHS Improvement and the Department of Health and Social Care, which will lead the digital technology agenda for government.

This will mean merging the commissioning and strategy functions that sit with NHS England with some of the higher-level policy and funding functions that sit with DHSC.

It will also mean seconding senior tech folk from NHS England (think Will Smart and Simon Eccles) and putting them in a unit with senior DHSC tech policy folk (eg Katie Farringdon).

NHSX will not have any formal status as a body - essentially borrowing its purpose from others - but that doesn’t mean it won’t have power. It is the biggest governance reshuffle for digital technology for at least half a decade and probably then some.

Among other powers, it will approve the distribution of hundreds of millions of pounds of central digital funding and control major IT contracts. It will have its own chief executive who will be accountable to NHSE/I and to Mr Hancock.

As revealed by HSJ in January, the formation of NHSX is driven partly by Mr Hancock’s frustration over too many competing voices at the technology table. Whether NHSX simplifies this landscape, or simply adds another forum for the cacophony, remains to be seen.

Both sides lose out

Paying for patients to recover and rehabilitate in private care homes is nothing new for the NHS, but it seems to have become more common as the NHS battles to reduce delayed transfers of care and community hospital beds fill up.

However, this approach’s success depends on the quality of care the homes can offer and how carefully trusts, working with the care provider, select suitable patients and monitor outcomes. If things go wrong, patients won’t make the progress they should, readmissions to hospital will rise and NHS money won’t be used effectively.

Trusts can be left high and dry when care homes run into trouble. This happened to East Kent Hospitals University Foundation Trust when the Care Quality Commission inspected Ami Lodge in Deal, where the trust had blockbooked all rooms.

Midway through the inspection – which rated the home “inadequate” – the trust gave notice on the deal and within weeks all NHS-funded patients had left. The home then closed and the trust has had to spot purchase beds elsewhere, likely to be a more expensive option.

The CQC report does not address the commissioning of the beds but notes there were no “clear or formal” criteria for determining who was admitted, and that weekly phone calls to discuss progress with the trust had been discontinued after March 2018. More than a fifth of patients had been readmitted to hospital and a third were not discharged from the home when expected.

The trust says it had a clear service specification and monitored quality. Its swift action after the start of the CQC inspection suggests quality problems may have been known about.

Closer working between the NHS and social care providers could offer the chance to push up quality and address some of the NHS’ problems. When it goes wrong, both sides lose out.

But the biggest losers are patients whose rehabilitation and future independence may be limited as a result; the NHS surely owes them a duty of care when commissioning beds.