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

The potentially deal-breaking conundrum remains unsolved.

System leaders are pushing for their new bundle of urgent and emergency standards to replace the four-hour target from April, well-placed sources have told HSJ –  but a big conundrum surrounding the new target remains unsolved.

The winter ahead will be the most challenging in recent memory, so postponing major targets shake-up until the spring is sensible (although certain aspects of the new “bundle”, like 12-hour waits from arrivals rather than decision to admit should be in use right away).

The new package of targets also includes ambulance response and handover times, which are also already right under the spotlight.

And the Royal College of Emergency Medicine argues persuasively that the new bundle of 10 measures (see box in article for list in full) when implemented in full will drive better care outcomes than the blunt, but for many years very useful, four-hour standard.

Number 10 and the Treasury have however still not given the plans the green light. Why not? 

HSJ understands senior ministers and their officials are understandably waiting to hear how NHS leaders propose the new system will be used to allow the government – and the public – to hold the NHS to account for its performance before giving the go-ahead.

As NHS Providers chief Chris Hopson rightly warns: “We need to reassure patients that any changes to measuring A&E waiting times is not simply about moving the goalposts.”

Condensing 10 relatively technical metrics into a more bite-size form which can be used like the four-hour standard as a bellwether for the NHS’ overall health is a challenging ask. NHS leaders have at least bought themselves some more time to come up with a solution, although they will be pretty busy with other matters.

Winter warmer

During her first NHS Providers speech as chief executive of the health service, Amanda Pritchard stressed the importance of supporting the “very stretched” social care system ahead of winter.

She said the fate of the health service is “inextricably linked” to the challenges faced by domiciliary care providers, which are having a direct impact on patient flow through hospitals.

Her comments are timed well with the announcement that clinical commissioning groups in Staffordshire and Stoke-on-Trent are setting aside £5m to fund recruitment and retention of care home staff in the area.

It is hoped the winter support package can tackle the rising demand on care homes and staff shortages in the sector – which are likely to have been impacted by compulsory coronavirus vaccines for workers.

The commissioners are working with Staffordshire County Council and Stoke-on-Trent City council and will allow care home providers to be able to apply for additional funding for staff retention schemes, including bonuses.

Other initiatives to support care homes include recruitment campaigns, additional funding for providers, increasing digital tools to improve scheduling and reducing travel time and paperwork.

However, recruitment takes time, so it’s hard to say how this scheme will improve the picture this winter when the support is needed the most.