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

HEE gets its share of the fudge

Among local NHS leaders, Health Education England has in recent years become the least popular NHS quango in a supremely competitive field.

That is a situation not all of its own making: Many would name staffing as their biggest problem, and HEE has become the target of much anger because it often can’t help. Its purview is mainly about preparing the future workforce, not helping out with today, and clinical training lead in times mean its impact is inherently slow. It also has the unpopular task of deciding which trusts and services won’t get the trainee medics they want to keep their services ticking over.

Yet the level of irritation also suggests HEE’s leadership hasn’t done everything right. It also means the news the organisation is having its wings clipped – confirmed on Tuesday morning – got a pretty warm welcome in the sector.

Both the circumstances of the announcement, and the detail of it, give rise to a little bafflement.

It was mentioned as an aside by the health and social care secretary at an official get together for local chief execs, about developing the long term plan, on Monday. He was seemingly unaware of the fact this confirmation would come as news to nearly everyone present, including the directors and staff affected. We are not aware if he said it accidentally, or accidentally-on-purpose.

The message he gave was that HEE would be accountable to NHS Improvement, and this certainly seems to be the impression national leaders want to get out.

In formal terms, HEE is a non-departmental public body reporting to the Department of Health and Social Care, with its own board, and indeed is in the process of recruiting a chair. In their own language, NHSI and HEE said it meant that “HEE will work jointly with NHSI to develop HEE’s mandate for 2019-20 onwards”, that “opportunities will be identified for HEE’s regional teams to align with the seven integrated regional teams” of NHS England and NHSI, and the NHS Leadership Academy would move from HEE to NHSI.

This fudge makes NHSI’s complex merger/non-merger with NHS England look like structural simplicity.

From jewel to millstone

When a contract for clinical waste management was agreed by 22 Yorkshire and Humber NHS trusts and disposal company Healthcare Environmental Services in August 2010, everyone involved gave themselves an almighty pat on the back.

Then chair of the Yorkshire Clinical Waste Consortium Penny Lawrence lauded the “brilliant result” and described the procurement process as the “best I’ve ever been involved with”.

Promising annual savings of £1.7m, the North of England Commercial Procurement Collaborative, which ran the procurement, went so far as to describe the deal as the “jewel” in its crown.

Eight years later, the jewel has lost its lustre.

While savings have undoubtedly been delivered, at least 17 trusts now face paying extra for their clinical waste disposal after the contracts were terminated following a failure by HES to keep waste storage levels in line with permits.

At least £1m of taxpayers’ money has been earmarked for the contingency plan, which itself does not paint a picture of the smoothest transition.

Documents obtained by HSJ revealed that clinical waste was transported hundreds of miles from Yorkshire to Slough for incineration last week.

This would not necessarily be hugely noteworthy, were it not for the fact that the method of transportation and incineration both constituted breaches of safety regulations.

The government has got around this by issuing numerous exemptions, which HES claims supports its assertion that there is a problem with clinical waste incineration capacity in England.

The situation is further complicated by allegations that rival waste companies have increased their incineration prices significantly, which means inflated prices for trusts.

To top it off, shadow health secretary Jonathan Ashworth stood up in the House of Commons on Monday (for the second time in a week) and demanded more answers. It seems what was once a jewel has rapidly turned into a millstone around the NHS’s neck.

Thank you chair

Penny for the thoughts of the rest of the Queen Elizabeth Hospital King’s Lynn Foundation Trust’s board following the resignation statement of chairman Edward Libbey on Monday.

As reported by HSJ, Mr Libbey said the trust, which was put back into special measures last month after inspectors raised major quality concerns, needed “a change in board leadership” to address the “significant cultural change” required for a turnaround.

It’s important to stress that at no point in the statement did Mr Libbey suggest any other board member in particular should join him in tendering their resignation.

But it would be very strange, very strange indeed, if Mr Libbey considered his own departure alone enough to represent a “change in board leadership”, which would logically imply changes to executive members too.

It would also be very strange if he did not realise the statement would put those left behind in a bit of a tricky spot.

The trust, which issued the statement on the chairman’s behalf on its website, told HSJ no other board members had informed it they were leaving. But clearly the trust and its leadership is in a difficult place.