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

The last few months have been some of the most testing ever for many NHS organisations, with covid stretching staff to their limits and capacity under strain.

So it is not that surprising that Medway Foundation Trust – which was at the epicentre of the latest wave – has struggled to maintain quality and timely care for all patients. The trust was badly affected by the more infectious Kent variant from late October onwards, long before it was formally identified.

The Care Quality Commission report into its emergency department lays out those care issues brutally. An inspection in mid-December found patients stuck in ambulances, too few staff (partly due to sickness), long delays before being transferred to a ward, and staff who felt they were unsupported by senior leaders.

A personal letter to emergency department staff from chief executive James Devine was also cited as contributing to low morale by nine members of staff who spoke to the CQC, although others did not share their feelings.

HSJ has obtained a copy of the letter where Mr Devine reminds staff of professional obligations after a number of heated incidents. But he also thanks them for their work and promises deeper analysis to understand their concerns. We have attached the letter in full to our story for readers to make up their own minds about it.

Chair pulls out

More change at the top team of University Hospitals of Leicester, as its long-standing chair Karamjit Singh is to step down in April, a year earlier than planned.

Mr Singh has chaired the major acute trust since 2014 and has spent 50 years in different national and local public service roles.

Although already towards the end of his tenure at the trust, Mr Singh said it would “make sense” for him to step down early.

“The trust needs to appoint a permanent new chief executive and that should be done by a new chair,” he said in a statement.

The trust’s leadership team is certainly under strain at the moment as there are ongoing investigations into a £46m hole that was discovered in the trust’s annual accounts for 2018-19.

Auditors have also said there is “anecdotal evidence” that former trust management may have “deliberately misreported the trust’s financial position”.

Meanwhile, the former chief executive and chief finance officer have both been referred to the CQC. HSJ understands this process is ongoing.

Acting chief executive Rebecca Brown has paid tribute to Mr Singh, describing him of leaving a “lasting legacy”.

However, the trust must now look to embed strong permanent leaders to guide it out of this financial crisis.

Podcast skewers the week’s big issues

Reasonable or “unnecessarily hostile”? This week’s HSJ Health Check debates an email University Hospitals Birmingham FT sent to it’s staff last week.

The email was trying to stop staff gaming the vaccine system to get a second dose before their allocated appointment, but more alarmingly it also threatened staff with regulatory or disciplinary action if they tried to do this.

This has prompted criticism of the trust, which is already having to answer tricky questions about its culture on other fronts, as so many NHS workers at the moment are “scared” and “exhausted”.

We also discuss another regulatory question, around whether the covid vaccine should be mandatory and why this approach has not been taken by the government.

On the subject of staff protection, we also discuss news that the health and safety watchdog has been forced to hand over almost a hundred names of whistleblowers and why the government white paper could help put a stop to this.

And according to new data exclusively published by HSJ patient “goodwill” towards the NHS has dropped steeply in the autumn. Is this surprising? Or to be expected considering the continued pressure on electives?