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

Crisis of confidence

It’s possible Care Quality Commission chief executive Ian Trenholm feels like his ears are burning at the moment — and not for good reasons. 

Last week, HSJ revealed confidence in Mr Trenholm and his senior team has dropped 10 percentage points — to just 34 per cent — in the space of a year.

Now, five unions have confirmed they are considering industrial action.

The unions — Unison, the Royal College of Nursing, the Public and Commercial Services Union, Unite, and Prospect — are balloting their members on a vote of no confidence in the CQC’s senior leadership.

The union’s main point of contention is broadband for homeworkers. The CQC has previously provided separate broadband lines for its 2,000 homeworkers. But the regulator is planning to stop this from 1 April in a bid to save money.

The CQC said the majority of its homeworkers — many of them inspectors — are using their own broadband anyway so don’t need an extra line installed.

The CQC has also said it will reimburse any staff for the cost of installing new broadband lines and have offered goodwill payments of £230 for all its homeworkers.

But Unison, on behalf of all the unions, said staff are “understandably alarmed” by the changes. It adds there has been “little consultation”, which the CQC denies.

To those who wait

It probably surprises no one emergency ambulances take longer to reach patients in rural areas. But HSJ’s analysis of average response times to “category one” calls — where the patient is thought to have a life-threatening condition, such as a cardiac or respiratory arrest — shows it’s more complicated than urban fast, rural slow. 

Although many rural areas faced long waits, some, such as Northumbria and much of the South West, fared much better. 

And some places with the longest waits for these ambulances would not be described by the average reader as being particularly isolated. The area covered by High Weald Lewes Havens Clinical Commissioning Group suffers from a poor road network and has a 11:29 minute average response time to match. South Kent Coast CCG, which has an average response time of 9:56, includes the Romney Marsh as well as the conurbations of Dover and Folkestone. The target time for category one calls is seven minutes. 

Performance at the 90th percentile is also concerning for some areas. For example, 10 per cent of patients needing a category one response in Shropshire will wait 21:32 or longer, which is far too long to save someone having a cardiac arrest, unless very effective CPR is ongoing.

Improving these times is likely to be expensive and most ambulance trusts simply don’t have the staff — by one estimate, nearly three times the responders would be needed to substantially boost performance in rural areas. 

Above all, HSJ’s analysis shows the importance of broken-down data: most statistics on ambulance response times are only at trust level. As CCGs merge, the data showing performance at more local level risks being subsumed into what may be a very different picture of performance across a wider area. That would be a disservice to all those for whom calling an ambulance means a lengthy wait.