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

Who is to blame on waste scandal?

Health minister Stephen Barclay confidently told Parliament on Tuesday there was ample capacity in England’s incinerators to dispose of the clinical waste collected by troubled firm Healthcare Environment Services from around 50 NHS trusts.

But documents obtained by HSJ shed new light on officials’ views on the current levels of capacity, which suggests the overall situation is not as clear cut.

Members of both NHS Improvement and the Environment Agency accepted in the last few months there were capacity issues, so the question now is how much has this impacted on HES’s ability to store and dispose of hospital waste properly?

Here, the government’s and HES’s answers differ significantly.

Mr Barclay said there is enough capacity in the market to eliminate HES’s excess waste. HES disputes this, and says paying the “increased prices” from other incineration providers is “unsustainable”.

The company faces a race against time to reduce its waste levels across four sites, or it will quickly become unsustainable regardless.

Meanwhile – despite having 15 contracts taken off them, HES show no sign of giving in and are planning legal action against the NHS trusts in question.

If that goes ahead, how will those trusts feel about spending money on legal costs as a result of a decision effectively made by the government?

Will IT harm cervical screening’s big switch?

Routine cervical screening has saved thousands of lives a year since it was introduced in the late 1980s. In less than 18 months, it is due a major upgrade, it will be the biggest shake up since its inception 30 years ago.

Testing will move from examining cell samples under a microscope to testing for the presence of human papillomavirus, which causes cervical cancer. It is a good move; trial data tells us HPV testing detects more cancers. But it could be scuppered by the creaking IT infrastructure it relies on to function, computers that are as old as the screening programme itself.

The move to HPV testing has been in the works for years. And experts have been warning since at least 2014 that the renewed screening programme will need a new IT infrastructure.

This seems to have fallen on deaf ears because last month the chief executive of Jo’s Cervical Cancer Trust, the UK’s largest specialist cervical cancer charity, wrote to Matt Hancock to raise “serious and growing concerns” with the existing IT system.

Robert Music is worried and did not mince his words to the new secretary of state. The current system “is insufficient, in parts unsafe and I am concerned that it presents significant clinical risk,” he said.

Among his concerns is a shortage of investment and innovation in IT. The computer backbone lacks flexibility; it is stifling the kind of innovation that could increase attendance rates. Mr Music thinks the inadequate investment and innovation is down to a lack of leadership and governance, in part at least.

Mr Music’s letter came to light the same week that two cancer researchers in London produced a paper saying if the NHS delays rolling out HPV screening by a year hundreds of cancers will be missed, which could cost at least £32m in quality adjusted life years lost.