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

A risk worth taking?

Writing for HSJ just weeks ago, Birmingham Women’s and Children’s Hospital Foundation Trust’s chief executive described bringing the troubled women’s unit under the wing of the much-lauded children’s hospital in 2017 as a risk worth taking, despite the potential reputational damage.

The expanded trust’s first Care Quality Commission report underlines the dilemma.

The new organisation has indeed lost the overall “outstanding” badge which was held by the children’s FT - the merged organisation is “good” overall - and this would not have been received as universally excellent news to its ambitious staff and leaders. It may not be a loss that is fair, but it is an important one to highlight: Ratings are still perhaps the most powerful incentive shaping the way the NHS is managed.

But a closer reading of the report reveals the children’s hospital itself has maintained the “outstanding” rating it received as a solo unit.

As well as merging with the women’s hospital, the FT embarged on becoming the lead provider for child and adolescent mental health service ”Forward Thinking Birmingham” in recent years - and it proved difficult to run the latter as a high quality service. Both still have their problems and FTB in particular took a long time to start moving in the right direction, but both have significantly improved, the CQC found.

The inspectorate was at pains to stress that while there is no “outstanding” badge overall, credit was due to the trust’s leadership and staff, and that there had been improvements despite challenging circumstances.

Ms Marsh told HSJ it would take many years for all areas of the trust to meet their potential. You’d hope judgements about reputation are made in full possession of the facts rather than an overall rating alone.

Weighing the pig

Another set of monthly data, another set of record lows - and far worse is in the post as winter cranks up.

Official NHS England data revealed performance against the overall four-hour target dropped to 83.6 per cent, while the figure for major type 1 emergency departments fell to 74.5 per cent. You can read all the grim details in our report here.

Congratulations are, however, due to everyone at Barnsley Hospital FT — the only trust to hit the target on both measures. An honorary mention also for Northumbria Healthcare FT, the only other trust to hit the overall target.

The decline in A&E performance is hugely alarming and is, of course, due to a perfect storm of factors including rising demand, a workforce shortage and a pensions crisis, the lack of substantive action on which is a scandal.

The data of 14 trusts was, however, missing. They are not officially reporting the four-hour standard at present because they are part of a trial of new emergency metrics which could replace the existing target from as early as next April.

The jury is still out on whether or not this is a wise idea.

But if a new metric(s) does replace the four-hour target and does fully illustrate the intolerable strain the service is under in the way the existing regime has done this week, it will be selling both patients and the service short.

You can weigh the pig in kilos or pounds, but it shouldn’t change the weight of the pig, to coin a phrase.