Daily Insight: It’s about cash, not categories

How does the NHS react to ambulance response times which everyone agrees have deteriorated so much that lives and health are being put at risk? A simple answer may be to recategorise some of the most serious conditions – but that is fraught with problems.

The Getting it Right First Time report on stroke suggests that recategorisation should be urgently considered. Although it is not explicit about what that could mean, the likelihood would be a return to the pre-2017-18 situation where strokes qualified for the fastest response – eight minutes. In March, the average response time for category two – which strokes are now classified as – was over an hour. That eats into the time in which thrombolysis or thrombectomy is likely to be most effective.

But as Janette Turner – an academic who did research into how categorisation was working under the current system – points out, pushing more people into category one may just pull down response times for that cohort (which includes immediately life-threatening cases such as cardiac and respiratory arrests).

The real problem, she suggests, is insufficient resources – particularly ambulance staff – to meet the demands and that is a problem which ought to have been tackled years ago.

Procurement progress proves ponderous 

Covid, Brexit and war have all contributed to severe and ongoing disruption to global supply chains. Dealing with delays, shortages and stock-outs arising as a consequence has occupied the time of NHS trust procurement teams since the pandemic began, straining their resources.

More broadly, their local health system and trust leaders are no less preoccupied. They are trying to create the necessary governance structures to manage their integrated care systems (without stifling them with red tape). On top of this they are facing tough savings targets and constrained financial resources. And all other bandwidth is taken up with the elective recovery agenda, which will occupy their planning for several years to come.

It is hardly surprising therefore that local systems across England have made slow progress in creating the 42 ICS-based procurement operations that NHS England’s snappily named Procurement Target Operating Model programme called for back in January 2021.

We canvassed each ICS about who they had appointed as their procurement lead, and what kind of structure they intend to use for their procurement team.

Most said they had not appointed a procurement lead – despite this being one of the first things PTOM wanted them to do – and only a handful had settled on their procurement operations’ team structure.

Given how little time there is for anything besides the elective backlog, and the remorseless focus on efficiencies that many ICSs will have to adopt if they’re to come close to breaking even, it seems likely to expect ICS-based procurement nationwide will not be a reality for some time to come.