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

The NHS Elective Recovery Plan, published earlier this year, settled on an ambitious target of the health service treating 30 per cent more patients in 2025 than it had in the year before the pandemic.

The first milestone in hitting this ambition – which was reported to be the subject of intense behind the scenes wrangling between the NHS and the government – was for systems to carry out 10 per cent more activity in 2022-23 than they had in 2019-20, before the pandemic.

But HSJ has seen data that reveals the NHS is falling short of these levels – hitting just 88 per cent of pre-covid levels from April to mid-June.

There are many reasons behind this, including covid occupancy levels being higher than anticipated, a lack of social care capacity and staffing shortages.

One trust director told HSJ the target was a “real tall order” in this context and a medical director at a major hospital added: “There is more we can do, but if we think there is a magic bullet or single solution to solve this we are deluding ourselves.”

Bucks’ bumpy start

Integrated care systems became a legal reality last week but it didn’t take long for the storm clouds of conflict to rumble over the new era of partnership.

NHS representatives have been accused by a county council leader of being disrespectful and marginalising towards their local authority counterparts.

The establishment of ICSs was compared to an “NHS steamroller coming down on us with a heavy hand” by Martin Tett of Buckinghamshire council, LGC reported.

He told the Local Government Association conference that despite “fantastic relationships” with NHS partners during covid, the arrival of the ICS meant that “relationships between local government and the NHS have never been worse”.

Buckinghamshire is a partner in the Oxfordshire, Buckinghamshire and Berkshire ICS. 

Cllr Tett added: “I’ve never felt more disrespected or marginalised as I now feel. Whenever we ask about the structures, we are just told ‘this is the way the NHS system has happened’. Quite frankly, it feels like an NHS steamroller literally coming down on us with a heavy hand.”

Mark Cubbon, chief delivery officer for NHS England, told council representatives he was “sorry to hear some of the experiences you’re seeing are different”.

He said the NHS had “a job” both “nationally” and “locally” to “hold people’s feet to the fire with this”, calling it “a massive change for everybody”.

Also on today

In this week’s edition of North by North West, Lawrence Dunhill reports on the early findings of a “full post-mortem on the extraordinary IT outage across four hospitals in Greater Manchester” in May, and in his editorial, HSJ editor Alastair McLellan says the stubbornness of covid leaves the NHS with brutal choices to make.