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

Systems must “get back [their] operational process muscle” and not expect problems just to be solved by more capacity, according to NHS England’s emergency care lead. 

Sarah-Jane Marsh said that NHSE has invested in “a lot” of capacity to improve urgent and emergency care in the past year — including more “permanent” general and acute beds, and investment in community and ambulance services.

But in an interview with HSJ, NHSE’s national director for urgent care said the health service now has to maintain and make best use of what’s been made available.

Ms Marsh said: “The NHS, as a whole, we need to get back to our operational process muscle. Increasing capacity, and all those things are really important, but we’ve got to make the best use of the capacity that we’ve got.

“The answer to every problem cannot just be more capacity.”

Her comments come after recently published NHSE analysis suggesting the acute sector was around 10 per cent less productive in 2023–24 than before the pandemic.

NHSE also last week updated systems on progress made on urgent and elective care recovery plans. This included the return of a controversial “incentives scheme” to reward trusts that carry out the most improvements.

Only 40 per cent of last year’s £150m “incentives” scheme was paid out after trusts failed to meet NHSE’s performance thresholds, HSJ analysis has shown.

Seeing less of BOB

An integrated care board has proposed cutting over 80 full-time equivalent posts to reduce operating costs by 40 per cent.

Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board’s proposals would slash full-time equivalent posts from 489.6 to 404, representing a 17.5 per cent reduction — and the executive team may see a reduction of up to a third. The chief clinical information officer role, created last autumn, is among those at risk.

Conversely, BOB plans to expand its strategy and partnerships team. Consultation documents indicate a shift in resources to providers, with the ICB taking a “light-touch coordination role” rather than performance management.

Moorhouse, a consultancy firm, is overseeing the consultation. NHSE has instructed ICBs to cut running costs by 30 per cent by 2025–26, with at least 20 per cent in 2024–25. However, BOB ICB aims for a 40 per cent reduction to align with its budget, currently exceeded by £13.5m.

Concerns exist about the impact on clinical knowledge and skills due to the proposed cuts. Resources might be transferred to system partners, with mental health and vulnerable services potentially moved to provider collaboratives.

The ICB aims to focus on core functions, reducing less valuable activities. It will shift from tactical assurance to system-wide themes and strategic improvement.

A staff consultation proposes restructuring and post reductions, subject to change after feedback. The ICB is engaging trade unions due to the potential for over 20 redundancies.

Also on

NHS capital spending, though well intentioned, suffers from systemic flaws, leading to delays, inefficiencies and unintended consequences, writes our Mythbuster Steve Black. And in North by North West, Lawrence Dunhill says Greater Manchester’s financial plight is leading to some pretty bleak decisions.